踝关节骨折的手术治疗  

Operative treatment for fracture of ankle

作　　者：刘英民[1] 朱志强[2] 刘钰[1] 董继兵[1] 

机构地区：[1]兖矿集团总医院外四科,山东邹城273500 [2]济宁市中区人民医院外科

出　　处：《中国骨伤》2007年第2期80-81,共2页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨骨折复位、手术内固定治疗踝关节骨折后的踝关节功能恢复和预后情况。方法:踝关节骨折153例,男118例,女35例;年龄15-62岁,平均36岁。按Danis-Weber AO分型:A型30例,B型95例,C型28例。损伤机制按Lauge-Hansen分类:旋前-外展型45例,旋后-外旋型骨折70例,旋前-外旋型28例,旋后-内收型10例。单踝骨折47例,双踝骨折70例,三踝骨折23例,合并腓骨骨折13例。合并下胫腓联合分离损伤71例损伤程度按Bonnin分度:Ⅰ度19例,Ⅱ度31例,Ⅲ度21例。153例均采用手术内固定治疗。BonninⅠ度损伤复位后采用松质骨螺钉经腓骨内固定;Ⅱ、Ⅲ度损伤复位后采用经腓骨骨折钢板螺钉内固定;Ⅰ、Ⅱ度损伤予以缝合断裂下胫腓韧带、骨间韧带;Ⅲ度损伤采用切取腓骨长肌腱或腓骨短肌腱一半替代修复下胫腓韧带。结果:153例得到6-14个月的随访,参照齐斌等的评定标准:优良121例,可20例,差12例。结论:踝关节的解剖复位可获得最佳的临床疗效,采用切开复位内固定术治疗踝关节骨折可保证踝关节获得解剖复位,最大限度地恢复踝关节功能。Objective： To discuss the joint function recovery and prognosis of the treatment of reduction and external fxation for ankle fracture. Method：One hundred and fifty-three cases of ankle fractures included 118 male and 35 female with the average age of 36 years ranging from 15 to 62 years. According to the Danis-Weber-AO typing ,30 cases were in type A ,95 were in type B,28 were in type C. According to the Lauge-Hansen classification of injury mechanism,there were 45 cases of type as pronation-abduction ,70 cases of type as supination-external rotation,28 cases of type as pronation-external rotation, 10 cases of type as supination-abduction. There were 47 cases of mono-ankle fracture,70 cases of double ankles,23 cases of Cotton＇s fracture, 13 cases of fibulas. There were 71 cases associated with disconnection of lower tibiofibular syndesmosis and according to graduation of Bonnin in injury,there were 19 cases in grade Ⅰ,31 in grade Ⅱ ,21 in grade Ⅲ. All of the 153 cases were treated with internal fixtion. The cases of injury of Bonnin Ⅰ were fixed by cancellous bone screw through fibulas and those of Bonnin Ⅱ and Ⅲ were fixed by plate and cancellous bone screw through fibulas after reduction. The lower tibiofibular syndesmosis was sutured in Bonnin Ⅰ and Ⅱ and was repaired with the homonymy half tendon of peroneus or peroneus brevis in Bonnin Ⅲ. Resuits：All cases were followed-up from 6 to 14 months. According to the evaluation standard of QI Bin. the result were excellent and good in 121 cases,fair in 20 cases,poor in 12 cases. Conclusion：Ankle fracture requires open reduction and internal fixtion more often, especially while the fragment of posterior malleous is so large that it should be anatomically reduced and immobilized with internal fixation. It can ensure anatomical joint restoration and union for the ankle fractures, only by achieving most satiafied kinematics of the ankle ioint.

关 键 词：踝关节 骨折 骨折固定术 内 外科手术 

分 类 号：R683.42[医药卫生—骨科学]