踝关节脱位法治疗包含复杂后踝骨折的脱位型三踝骨折  

Dislocating the ankle joint to treat dislocated trimalleolar fractures accompanied with complicated hock fractures

作　　者：邢文钊[1] 王倩[2] 张立元[1] 邸军[1] 代嘉[1] 张纯朴[1] 崔健[1] 张志国[1] 

机构地区：[1]河北医科大学第三医院骨伤科,石家庄050051 [2]山东省济宁市第一人民医院骨科

出　　处：《中华创伤骨科杂志》2013年第3期193-197,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨踝荚节脱位法治疗包含复杂后踝骨折的脱位型三踝骨折的治疗方式和临床疗效，方法自2000年6月至2009年6月收治复杂后踝骨折的脱位型三踝骨折患者29例，男19例，女10例，年龄20～67岁，平均37岁；损伤根据Iauge—Hansen分类：旋后外旋型18例，均为Ⅲ度；旋前订外展刮11例，均为Ⅳ度。骨折按照I）anis—Weber（AO／ASIF）分型：B型19例，C型10例。患者均采用踩火节外侧脱化法，充分硅露后踝，直视下复化骨折块，用可吸收螺钉可靠同定。术后疗效采用Baird—Jackson评分进行评定。结果本组患者手术时间为45—85min，平均65rain。术后1例患者伤口二期愈合．其他均一期愈合。所有患者术后获8～30个月（平均14个月）随访，均达骨折临床愈合，愈合时间3～5个门（平均4个门），无一例发生距骨坏死。无内固定物松动、脱出、断裂等发生。术后疗效按Baird—Jac：kson渖分评定：优20例，良7例，可2例，优良率为93．1％。结论对于包含复杂后踝骨折的脱化掣三踝骨折的术中复位采用踝关节脱他法可以使关节软骨面精确复位，治疗效果良好。Objective To discuss the effect of dislocating the ankle joint in treatment of dislocated trimalleolar fracture accompanied with a complicated hnek fracture. Methods From June 2000 to June 2009, 29 patients were treated in our department by dislocating the ankle joint for dislocated trimalleolar fracture accompanied with a enmplicated hock fracture. They were 19 men and 10 women, aged from 20 to 67 years （awwage, 37 years） . According to the Lauge-Hansen classification, there were 18 cases of supinatkm-externai rotatioo type Ⅲ and 11 cases of pronation-external rotation type IV. According to the l）anis-Weber （AO/ASIF） system, there were 19 cases of type B and 10 cases of type C. A medial malleolus incision was made to dislocate the ankle joint and to expose the hock before reduction of bone fragments under direct visualization followed by rigid fixation with absorbable screws. The Baird-Jackson evaluation system was used to assess surgical outcomes. Results The operating time averaged 65 minutes, ranging from 45 to 85 minutes. All wounds healed at the first stage except one that healed at Ihe secondary stage. The patients obtained an average follow-up of 14 months （from 8 to 30 months）. All fractures achieved clinical uniun after 3 to 5 months （average, 4 months） postsurgery. No talar necrosis or implant failure occurred. By the Baird-Jackson evaluation system, 20 cases were excellent, 7 good and 2 fair, giving a good to excellent rate of 93. 1%. Conclusion Dislocating the ankle joint can help achieve precise reduction of the articular cartilages and consequently satisfactory results in the treatment of dislocated trimalleolar fracture, accompanied with a complicated hock fractures.

关 键 词：踝关节 骨折 脱位 骨折固定术 内 骨钉 

分 类 号：R687.3[医药卫生—骨科学]