切开复位和韧带修复治疗三踝骨折伴下胫腓联合分离的临床分析  

Clinical analysis of open reduction and ligament repair for treatment of trimalleolar ankle fracture with syndesmotic separation

作　　者：鞠金勇 肖海军[1] 石伟哲[1] 喻都 

机构地区：[1]辽宁医学院上海市奉贤区中心医院研究生培养基地/上海市奉贤区中心医院骨科,201499

出　　处：《疑难病杂志》2016年第5期483-486,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：上海市医学重点专科项目(ZK2012A09)

摘　　要：目的探讨切开复位和韧带修复治疗三踝骨折伴下胫腓联合分离的疗效。方法回顾性分析2012年1月—2014年12月上海市奉贤区中心医院骨科就诊的三踝骨折伴下胫腓联合分离的患者43例。患者均行切开复位内固定治疗,外踝用锁定钢板固定,后踝用2~3枚螺钉固定,内踝用1~2枚螺钉固定,固定三踝稳定踝关节,检查并修复损伤的三角韧带、下胫腓联合后韧带等。术毕外旋应力位透视,43例患者下胫腓联合间隙均〈5 mm,提示下胫腓联合稳定,故均未固定下胫腓联合。距骨前后平移试验阴性,提示踝关节稳定。定期随访,按Baird-Jackson踝关节评分标准对踝功能进行评价。结果 43例患者均获得随访,时间为8~24（16.0±0.5）个月,切口愈合时间8~15（12.3±1.4）d,全部获骨性愈合,平均愈合时间4~6（4.7±0.5）个月;Baird-Jackson踝功能评分84~98（96.4±5.6）分,其中优34例（79.1%）,良5例（11.6%）,可4例（9.3%）,优良率达90.7%。结论切开复位及修复损伤韧带治疗三踝骨折伴下胫腓联合分离能够稳定踝关节和下胫腓联合,疗效显著。Objective To explore the therapeutic effect of open reduction and ligament repair for treatment of trimalleolar ankle fracture with syndesmotic separation.Methods From January 2012 to December 2014,43 cases of trimalleolar ankle fracture with syndesmotic separation came to our hospital for treatment.They were all treated by open reduction and internal fixation;external malleolus with locking plate fixation,posterior malleous with 2-3 pieces of screws fixation,medial malleolus with 1-2 pieces of screws fixation.We fixed three ankle to stabilize the ankle joint,then checked and repaired deltoid ligament,tibiofibular posterior ligament and so on.All cases were confirmed by fluoroscopic image in the external rotation position after operation.Every gap of tibiofibular syndesmosis of 43 cases was less than 5 mm,which indicates syndesmotic stabilization.So the tibiofibular syndesmosis of 43 cases was not fixed.Talus before and after translation test negative,suggesting that the ankle joint stability.They were followed up on a regular basis.According to Baird-Jackson＇ s standar of ankle joint,they were graded.Results 43 cases were all followed up ranging from 8-24（16.0 ±0.5） months.The incision healing time was ranging from 8-15（12.3±1.4） days.If all were healed,the average healing time was 4-6（4.7 ±0.5） months.The mean Baird-Jackson ankle-hindfoot score was 84-98（96.4 ±5.6） points.34 cases（79.1%） were excellent,5 cases（11.6%） were good;4 cases（9.3%） were moderate,the percentage of excellent or good clinical results was 90.7%.Conclusion Open reduction and ligament repair for treatment of trimalleolar ankle fracture with syndesmotic separation can fix the ankle joint and tibiofibular syndesmosis,which has an evident effect.

关 键 词：三踝骨折 下胫腓联合分离 后踝固定 韧带修复 

分 类 号：R687.3[医药卫生—骨科学]