重建旋前外旋Ⅳ度踝关节骨折下胫腓联合稳定性的疗效分析  

Effectiveness analysis of reconstruct syndesmotic stability in pronation-external rotation type Stage 4 ankle injuries

作　　者：张振宇[1] 李成[1] 马静[1] 

机构地区：[1]辽宁省锦州市中心医院,辽宁锦州121000

出　　处：《中国医学工程》2014年第4期27-27,30,共2页China Medical Engineering

摘　　要：目的评价手术重建旋前外旋Ⅳ度踝关节骨折下胫腓联合稳定性的效果及踝关节功能恢复情况。方法分析2008年3月-2013年1月我院收治的53例Ⅳ度不伴有三角韧带损伤旋前外旋型踝关节骨折手术病例。手术方法为外踝钢板固定,内踝2枚螺钉固定,修补下胫腓联合前韧带,依后踝骨块大小决定是否进行螺钉固定。然后进行拉钩试验检测下胫腓联合稳定性。若不稳定,加行下胫腓螺钉固定。术后定期随访复查。结果随访12-48个月,平均18个月。所有病例骨折均愈合,术后均未发现下胫腓联合分离。后踝固定33例,未固定后踝20例。术中拉钩试验共发现14例下胫腓联合不稳,均为未固定后踝患者。末次随访时按AOFAS踝关节-后足评分标准,后踝固定组优良率为84.8%;未固定后踝组优良率为75.0%。两组优良率比较无显著性差异（P〉0.05）。结论对于旋前外旋型Ⅳ度踝关节骨折,后踝固定与否是决定能否有效重建下胫腓联合的稳定性的重要因素。【Objective】To evaluate clinical effects and ankle function by reconstruction syndesmotic stability in pronation-external rotation type（PER） Stage 4 ankle injuries.【Methods】 From March 2008 to January 2013,53 patients with PER Stage 4 ankle fracture without injury of the deltoid ligament were treated. Open reduction and plate compression internal fixation was performed in fibula and medial malleolu was fixed by two screws,then anteroinferior tibiofibular ligament was mended. The sizes of the posterior malleolus were evaluated to decide to be fixed or not. Then the Hook test was performed to evaluate the syndesmotic stability.If unstability,the syndesmotic would be fixed by screws.【Results】All the patients were followed up 12-48months（mean,18 months）. All the fractures were healed. There was no inferior tibiofibular syndesmosis split cases after operation.There were 33 cases＇ posterior malleolus were fixed and 20 cases were not fixed.14 unstable cases without fixing posterior malleolus were founded during operation by Hook test. According to AOFAS ankle-hindfoot scoring system, the fixing posterior malleolus group＇s exellent and good rate was 84.8%,and in the not fixing group＇s 75.0%,but there was no statistically significant difference between two groups（P〉0.05）.【Conclusion】In PER Stage 4 ankle fracture,the fixing posterior malleolus or not is one of the important factor that constructs the syndesmotic stability effectively.

关 键 词：旋前外旋型 踝关节骨折 胫腓下联合分离 

分 类 号：R274.1[医药卫生—中医骨伤科学]