踝关节镜辅助下切开复位内固定治疗踝关节骨折的疗效  

Surgical treatment of acute ankle fractures with arthroscopy-assisted open reduction and internal fixation

作　　者：王珂杰[1] 徐鹏[1] 严伟洪[1] 李欢[1] 刘锦波[1] 丁文鸽[1] WANG Ke-jie XU Peng YAN Wei-hong LI Huan LIU Jin-bo DING Wen-ge(Department of Orthopaedics, Changzhou No. 1 People＇s Hospital, Jiangsu Changzhou 213003, China)

机构地区：[1]常州市第一人民医院骨科

出　　处：《足踝外科电子杂志》2015年第3期17-20,共4页Electronic Journal of Foot and Ankle Surgery

基　　金：国家自然科学基金(81272017)

摘　　要：目的探讨踝关节镜辅助下治疗踝关节骨折的临床疗效。方法选取2014年1月至2014年12月对20例踝关节骨折采取踝关节辅助下切开复位内固定手术。骨折按照Lauge-Hansen分类法旋后外旋10例，旋前外展4例，旋前外旋4例，旋后内收2例。平均年龄（36．8±11．7）岁。所有患者在踝关节镜辅助下行骨折切开复位内固定手术，切开复位前行踝关节镜探查明确关节软骨及韧带损伤情况，软骨损伤者取出游离体并行微骨折治疗，下胫腓联合韧带损伤者行双Endbutton钢板治疗下胫腓联合韧带损伤，内踝三角韧带损伤者修补三角韧带。术后临床疗效采用美国足踝外科协会（AOFAS）评分系统进行评价。结果20例患者术后随访1年，AOFAS术前评分（44．3±8．18）分，术后1年（90．7±4．19）分，差异有统计学意义（P〈0．05）。踝关节镜证实有软骨损伤患者术后1年的AOFAS评分较无软骨损伤患者低，差异有统计学意义（P〈0．05）。下胫腓联合损伤患者术后1年的AOFAS评分较无损伤患者低，差异有统计学意义（P〈0．05）。结论踝关节骨折常常合并关节内软骨损伤或者关节周围韧带损伤，且发生关节软骨损伤或者关节周围韧带损伤患者术后1年AOFAS评分较未发生者低。踝关节镜辅助下切开复位内固定治疗踝关节骨折可以发现关节周围韧带损伤及治疗关节内软骨损伤，并且可以在镜下观察复位效果，具有较好的临床应用前景。Objective Clinical results of arthroscopy-assisted open reduction and internal fixation for the treatment of acute ankle fractures. Methods A retrospective cohort of study was done in 42 patients of acute ankle fractures treated with arthroseopy- assisted open reduction and internal fixation from January 2014 to December 2014.According to Lauge-Hansen classification,there were 10 pronation-external rotation fractures,4 supination-adduction fractures,4 supination-external rotation fractures,2 pronation-adduction fractures, with all average age of （36.8 ~ I 1.7） years.All patients were treated with arthroscopy assisted open reduction and internal fixation and intra-articular disorders were observed and treated at the same time.Syndesmotie injury was treated with double endbutton plate and osteoehondral injuries were disposed with the assist of arthroscopy.All the clinical effects were evaluated according to AOFAS scores. Results All the patients were followed up for one year. At the final review, the mean AOFAS score was （90.7 ± 4.19） compared with （44.3 ± 8.18） pre-operated （P〈0.05）.The AOFAS scores of patients with osteochondral lesions were lower than those of patients without osteochondral lesions （P〈0.05）.The AOFAS scores of patients with syndesmotie injury were lower than those of patients without （P〈0.05）. Conclusion Intra-artieular injuries are common in acute ankle fractures, and osteochondral lesion and sydesmosis injury are the most important prognostic factor that leads to unsatisfactory ankle functions. Arthroseopy assisted open reduction and internal fixation for the treatment of acute ankle fractures is helpful for diagnosis and treatment of osteochondral lesion and sydesmosis injury and has a promising application prospect.

关 键 词：踝关节镜 踝关节骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]