踝关节骨折畸形愈合的临床治疗  

The clinical treatment of malunited ankle fracture

作　　者：梁彦[1] 和利[2] 李卫哲[3] 田维[3] 贾健[3] 

机构地区：[1]天津医科大学,天津300000 [2]宁河县医院 [3]天津医院

出　　处：《山东医药》2012年第16期25-27,共3页Shandong Medical Journal

摘　　要：目的探讨踝关节骨折畸形愈合的术前评估、手术方法及其临床疗效。方法 2004年6月～2011年3月,共收治踝关节骨折畸形愈合患者16例。15例患者MRI检查关节软骨损伤小于Ⅳ级,行切开截骨矫形,应用内固定加外固定支架联合固定;1例患者关节软骨损伤为Ⅳ级,行踝关节融合术。结果 16例患者均获随访,随访时间6～87个月、平均30.8个月。骨折愈合时间12～17周、平均13.2周。术后踝关节AOFAS评分为58～92分、平均82分,优良率为81.3%。术后无深部感染、内固定失效、骨不连、畸形复发等并发症发生。其中2例患者发生皮缘坏死,1例钉道表浅感染,且经对症处理后获痊愈。结论 MRI检查有助于评估关节软骨的损伤程度,确定手术方案,对关节软骨损伤小于Ⅳ级的患者,经截骨矫形后,应用内固定加外固定支架联合固定为一种有效的治疗方式。Objective To explore the preoperative evaluation, surgical methods and clinical results of malunited ankle fracture. Methods From June 2004 to March 2011, 16 patients of malunited ankle fracture were treated in our hospital. Fifteen cases whose articular cartilage injury was less than IV level in MRI were operated by osteotomy and fixed with interi- or and external fixation. One case whose articular cartilage injury was IV level in MRI was operated by fusion joint ankle. Results All patients were followed-up on an average of 30.8 months （ range 6 to 87 months）. The time of fracture union was 13.2 weeks （ 12-17 weeks）. The postoperative AOFAS ankle score was 82 （58-92） , good rate was 81.3%. In 16 ca- ses, there were no deep infection, internal fixation failure, fracture nonunion, deformity recurrence. The skin edge necrosis occurred in 2 case and the superficial infection of screw road was seen in 1 case. All these three cases were cured by symp- tomatic treatment. Conclusions MRI is important to appraise the severity of articular cartilage injury and choose the surgical methods. Operated with osteotomy and fixed with interior and external fixation for the cases whose articular cartilage injury is less than IV level in MRI is an effective way.

关 键 词：踝关节 骨折 外固定器 畸形愈合 

分 类 号：R683.42[医药卫生—骨科学]