伴撕脱性骨折的踝关节"Logsplitter"损伤未行下胫腓联合螺钉固定的疗效  

Surgical effectiveness of ankle"Logsplitter"injury plus avulsion fractures without tibiofibular joint screwing

作　　者：王建[1] 范江伟 曹明宇[1] 王成伟[1] Wang Jian;Fan Jiangwei;Cao Mingyu;Wang Chengwei(Department of Orthopaedics,The Sixth Affiliated Hospital,Xinjiang Medical University,Urumuqi 830000,China)

机构地区：[1]新疆医科大学第六附属医院骨科,乌鲁木齐830000

出　　处：《中华创伤骨科杂志》2020年第1期49-54,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨"Logsplitter"损伤伴Tillaux-Chaput骨折/Wagstaffe-Lefort骨折与Volkmann骨折未行下胫腓螺钉固定的疗效。方法回顾性分析新疆医科大学第六附属医院骨科自2015年1月至2018年12月采用切开复位内固定治疗的16例踝关节"Logsplitter"损伤伴Tillaux-Chaput骨折/Wagstaffe-Lefort骨折的患者资料。男11例,女5例;年龄27~56岁,平均36.4岁;开放性损伤2例(根据Anderson-Gustilo分型:Ⅱ型1例,ⅢA型1例),闭合性损伤14例;骨折AO/OTA分型均为44-C型。根据Lauge-Hansen分型:旋前外展型9例,旋前外旋型3例,旋后外旋型4例。采用外侧单一切口,复位腓骨骨折后用接骨板固定,Tillaux-Chaput骨折/Wagstaffe-Lefort骨折采用螺钉或克氏针固定,Volkmann骨折用螺钉固定。术后采用美国足踝外科协会(AOFAS)的踝-后足评分、肌肉骨骼功能(SMFA)障碍指数、肌肉骨骼功能困扰指数评价踝关节功能。结果所有患者术后随访8~27个月,平均21.3个月。X线片示所有骨折均达骨性愈合,愈合时间12~18周,平均14.8周。末次随访时13例均行走正常,3例轻度不适。AOFAS的踝-后足评分为86~100分(平均96.3分),其中优12例,良3例,差1例。SMFA障碍指数为8~17分(平均15.9分),SMFA困扰指数为3~9分(平均6.5分)。结论"Logsplitter"损伤伴Tillaux-Chaput骨折/Wagstaffe-Lefort骨折与Volkmann骨折时,术中固定Tillaux-Chaput骨折块或Wagstaffe-Lefort骨折及Volkmann骨折重建下胫腓水平稳定"环",未行下胫腓螺钉固定,可以获得满意的疗效。Objective To explore the surgical efficacy of trans-syndesmotic ankle fracture dislocation(the"Logsplitter"injury)plus the Tillaux-Chaput fracture/the Wagstaffe-Lefort fracture and the Volkmann fracture without tibiofibular joint screwing.Methods Between January 2015 and December 2018,16 adult patients with the"Logsplitter"injury plus avulsion fractures were treated by open reduction and internal fixation at Department of Orthopaedics,The Sixth Affiliated Hospital,Xinjiang Medical University.They were 11 males and 5 females with an average age of 36.4 years(range,from 27 to 56 years).There were 2 open fractures(one typeⅡand one typeⅢA by the Anderson-Gustilo classification)and 14 closed ones;all fractures were type 44-C by the AO/OTA classification;according to the Lauge-Hansen classification,there were 9 cases of pronation-abduction rotation,3 cases of pronation-external rotation and 4 cases of supination-external rotation.The fibular fractures were treated through a single lateral approach followed by plate fixation.The Volkmann fractures were fixed with screws and the Tillaux-Chaput fractures/the Wagstaffe-Lefort fractures with screws or Kirschner wires.The ankle functions were assessed postoperatively using the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society(AOFAS),and the dysfunction index and bother index of Short Musculoskeletal Function Assessment(SMFA).Results All the patients were followed up for 8 to 27 months(average,21.3 months).X-ray films showed complete fracture healing in all cases after 12 to 18 weeks postoperatively(mean,14.8 weeks).At the last follow up,13 patients walked normally and 2 with mild discomfort.Their AOFAS scores averaged 96.3(range,from 86 to 100),giving 12 excellent,3 good and one poor cases;their SMFA dysfunction index was 15.9(range,from 8 to 17)and SMFA bother index 6.5(range,from 3 to 9)at the last follow-up.Conclusions In the treatment of trans-syndesmotic ankle fracture dislocation-the"Logsplitter"injury,open reduction and internal fixat

关 键 词：踝关节 骨折 骨折固定术 内 Logsplitter损伤 下胫腓联合 

分 类 号：R687[医药卫生—骨科学]