踝关节镜辅助治疗踝关节骨折并下胫腓分离的疗效分析  

Efficacy Analysis of Ankle Arthroscopy-assisted Treatment for Ankle Fractures Combined with Inferior Tibiofibular Syndesmosis Separation

作　　者：刘永青[1] 李杰峰[2] 苟中坤[2] 林序文[2] 余海滨[1] 何启新[1] 钟文辉[2] 赖西铭[2] 

机构地区：[1]广东省东莞市太平人民医院骨外科,广东东莞523900 [2]广东省东莞市太平人民医院手足外科,广东东莞523900

出　　处：《临床医学工程》2011年第7期997-998,共2页Clinical Medicine & Engineering

基　　金：2009年东莞市科技计划项目(编号:2009105150103)

摘　　要：目的探讨踝关节镜下辅助治疗踝关节骨折并下胫腓分离的优点及体会。方法 2009年5月至2010年12月间,笔者收集了9例踝关节骨折并下胫腓分离病例,下胫腓分离按Lauge-Hansen分型：旋后-外旋型4例,旋前-外旋型4例,旋前-外展型1例;其中同时合并关节韧带损伤6例,距骨骨折4例,内踝、外踝或后踝骨折7例。分别作踝关节镜下关节内清理、骨折内固定术,其中6例行下胫腓联合固定。结果术后9例全部随访,时间为8~28个月,平均15.6个月,定期复查X线片均示骨折愈合良好,6例下胫腓联合固定良好,于术后8～12周取出下胫腓联合内固定螺钉;根据Baird-Jackson系统评分：优5例;良3例;可1例;优良率达88.9%;无一例感染、断钉、踝关节不稳定及创伤性关节炎等并发症发生。结论踝关节镜下辅助治疗踝关节骨折并下胫腓分离可直视下探查,明确诊断下胫腓联合固定与否;其手术损伤小,有利于踝关节的早期功能锻炼,减少并发症,使患者术后功能得到较好恢复。Objective To explore the advantages and experience of ankle arthroscopy-assisted treatment for ankle fractures combined with inferior tibiofibular syndesmosis separation.Methods From May 2009 to December 2010,the authors collected 9 cases of ankle frac tures combined with inferior tibiofibular syndesmosis separation,the inferior tibiofibular syndesmosis separation was classified according to Lauge-Hansen classification：4 cases of supination-external rotation type,4 cases of pronation-supination type,one case of pronation-out-reach;among whom 6 cases combined with ligament injury,4 cases combined with talus fractures,7 cases combined with medial malleolus,lateral malleolus or posterior malleolus fractures.All the cases were respectively given the intra-articular clean-up under arthroscopy and fracture fixation,among whom 6 cases were given tibiofibular syndesmosis fixation.Results After surgery,all the cases were followed up for 8 to 28 months,with an average of 15.6 months.Regular review of X-ray showed that fracture healing was good,inferior tibiofibular syn desmosis fixation of six cases was good,inferior tibiofibular syndesmosis intra-fixation screws were removed in 8 to 12 weeks;according to Baird-Jackson system score：5 cases were excellent;3 cases was good;one case was fair;the excellent and good rate was 88.9%;no case of infection,broken nails,ankle instability and traumatic arthritis and other complications occurred.Conclusion The ankle arthroscopy-assisted treatment for ankle fractures combined with inferior tibiofibular syndesmosis separation can probe under direct vision for clearl diagnosis of inferior tibiofibular syndesmosis fixation;the treatment has few surgical injury,which is helpful for patients to do early ankle exercise,re duce complications,and get better postoperative functional recovery.

关 键 词：踝关节镜 踝关节骨折 下胫腓分离 

分 类 号：R687.3[医药卫生—骨科学]