三柱理论在踝关节骨折合并下胫腓联合损伤治疗中的应用  

New strategy for the treatment of ankle joint fracture combined with ankle syndesmosis injury

作　　者：王朝亮[1] 黄素芳[1] 朱涛[1] 孙雪生[1] 康颂科[1] 李新霞[1] 申立林[1] 蔺楚[1] 王英振[2] 周东生[3] 

机构地区：[1]泰山医学院附属莱芜医院骨二科,山东省莱芜市271100 [2]青岛大学医学院附属医院关节外科 [3]山东大学附属省立医院 山东省骨科医院创伤骨科

出　　处：《中华解剖与临床杂志》2016年第3期236-241,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的：探讨三柱理论指导踝关节骨折合并下胫腓联合损伤内固定治疗的临床效果。方法回顾性分析2008年6月—2014年5月泰山医学院附属莱芜医院骨二科收治的54例踝关节骨折合并下胫腓联合损伤患者的临床资料。其中男43例,女11例；年龄21-58岁,平均36.7岁。根据影像学表现出的病理解剖特点及受伤机制,将踝关节按形态分为三柱；踝关节骨折合并下胫腓联合分离时,三柱均累及,其中外侧柱损伤54处,中间柱韧带损伤26处,中间柱撕脱骨折28处,内侧柱韧带损伤31处,内侧柱骨折23处。54例患者根据损伤的不同柱别选择入路行内固定治疗,其中固定两柱26例,固定三柱28例。术后6个月疼痛情况采用VAS评分,踝关节功能评价采用美国足踝外科医师协会（ American Orthopaedic Foot and Ankle Society, AOFAS）踝-后足评分系统,骨折复位固定后综合评价采用改良Baird和Jackson评估标准。结果54例患者获得随访,随访时间6-48个月（平均21个月）,骨折愈合时间为11-15周（平均13.6周）,疼痛VAS评分为0-6分（平均1.4分）,术后随访踝关节功能 AOFAS 踝-后足评分：82-100分,平均96分。综合疗效评定：优52例,良2例,优良率为100%。结论踝关节骨折三柱分型是一种既简单又全面的分型理论,三柱损伤后固定两柱可以达到稳定下胫腓联合的目的。Objective To investigate the guidance of three-column theory in decision-making of ankle joint fracture combined with syndesmosis injury and its result.Methods Fifty-four patients（43 males and 11 females） of ankle joint fracture combined with inferior tibiofibular syndesmosis injury classified by three-column theory and treated by open reduction internal fixation（ ORIF） were reviewed from June 2008 to May 2014. The mean age of the patients was 36. 7 years old（ranged from 21 to 58 years old）. Among all the ankle joint fracture combined with inferior tibiofibular syndesmosis separation, three columns were involved, the lateral column injury in 54, middle column ligament injury in 26, middle column avulsion fracture in 28, the inner side column ligament injury in 31, medial column fracture in 23. Fifty-four patients were perfamed internal fixation according to different damage columns, including 26 patients with two columns fixation and 28 patients with three columns fixation. Visual analogue scale（ VAS） pain scores were recorded at 6 months after surgery. The function of ankle joint was assessed by American Orthopaedic Foot and Ankle Society （ AOFAS） ankle-hindfoot score system. Imaging results were evaluated using modified Baird and Jackson evaluation criteria after fracture reduction and fixation.Results Fifty-four patients had been followed up. The average follow-up time was 21 months ranging from 6. 0 to 48. 0 months. The average healing time was 13.6 weeks ranging from 11. 0 to 15. 0 weeks. The pain VAS score ranged from 0 to 6 （mean 1. 4）. Postoperative follow-up of ankle function, ankle hind foot score from 82 to 100 （mean 96） points according to AOFAS evaluation system, an average of 96 branches. Radiological evaluation of curative effect：excellent in 52 cases, good in 2 cases, the excellent and good rate was 100%（ 54/54 ） according to Baird and Jackson＇s radiology evaluation system.Conclusions As a simple and comprehensive classification,two columns of three columns fixa

关 键 词：骨折 踝关节 下胫腓联合损伤 骨折固定术 内 功能评价 

分 类 号：R687.3[医药卫生—骨科学]