有限内固定结合外固定支架在开放性踝关节骨折伴完全脱位中的应用  

Application of limited internal fixation combined with external fixation in open ankle fracture with complete dislocation

作　　者：刘跃飞[1] 巨积辉[1] 周荣[1] 胡昌庆[1] 杨亮 杨开航 陈鲁成 侯瑞兴[1] LIU Yuefei;JU Jihui;ZHOU Rong;HU Changqing;YANG Liang;YANG Kaihang;CHEN Lucheng;HOU Ruixing(Department of Foot and Ankle Surgery,Ruihua Hospital Affiliated to Soochow University,Jiangsu 215104,China)

机构地区：[1]苏州大学附属瑞华医院足踝外科

出　　处：《足踝外科电子杂志》2019年第3期17-20,24,共5页Electronic Journal of Foot and Ankle Surgery

基　　金：江苏省青年医学人才项目(QNRC2016224)

摘　　要：目的探讨有限内固定结合外固定支架治疗开放性踝关节骨折伴完全脱位的临床疗效。方法2016年10月~2018年6月共收治开放性踝关节骨折伴完全脱位13例。按照AO分型,踝关节骨折43-B1型1例,44-A1型3例,44-A2型3例,44-B3型4例,44-C2型2例。依据Gustilo分型,开放性骨折Ⅱ型7例,ⅢA型3例,ⅢC型3例。急诊行骨折复位有限内固定结合跨踝关节外固定支架固定。结果术后13例患者伤口一期愈合10例,3例伤口结痂愈合。13例患者均获得随访,时间6~24个月,平均14个月。骨折愈合时间12~24周,平均16周。根据美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分系统评分:优9例,良2例,可2例,优良率84.6%。结论对于开放性踝关节骨折伴完全脱位采用有限内固定结合外固定支架治疗,可以获得较为满意的复位,同时有利于减少软组织损伤,稳定踝关节,促进软组织、韧带愈合,减少术后皮肤坏死及伤口感染等并发症的发生,利于踝关节功能的恢复。Objective To investigate the clinical efficacy of limited internal fixation combined with external fixation in treatment of open ankle fracture and complete dislocation.Methods From October 2016 to June 2018,13 cases of open ankle fractures and complete dislocation were treated.According to AO classification,there were 1 case of ankle fracture 43-B1,3 cases of 44-A1,3 cases of 44-A2, 4 cases of 44-B3 and 2 cases of 44-C2.According to Gustilo classification,there were 7 cases of open fracture type Ⅱ,3 cases of type ⅢA and 3 cases of type ⅢC.All cases underwent emergency fracture reduction and internal fixation combined with spanning external fixation of the ankle joint.Results After the operation,the wound in 10 cases achieved primary healing,and scar healing occurred in 3 cases.All the 13 patients were followed up for 6 to 24 months with an average of 14 months.The bone union time was 12 to 24 weeks with an average of 16 weeks.According to the American orthopaedic foot and Ankle Society (AOFAS) ankle-hindfoot score: the excellent was in 9 cases,the good was in 2 cases,the fair was in 2 cases,and the excellent and good rate was 84.6%.Conclusion For open ankle fracture with complete dislocation,limited internal fixation combined with external fixator can achieve satisfactory reduction.It is also conducive to reducing soft tissue injury,stabilizing ankle joint,promoting soft tissue and ligament healing,reducing skin necrosis and wound infection after operation,and conducive to ankle junction.

关 键 词：踝关节 脱位 骨折 外固定 

分 类 号：R683.42[医药卫生—骨科学]