经腓骨截骨复位内固定治疗中老年累及后踝陈旧性踝关节骨折  

Transfibular osteotomy with open reduction and fixation for treatment of old ankle fractures involving the posterior malleolus in middle-aged and elderly patients

作　　者：苏琰[1] 李振东 薛剑锋[1] 邹剑[1] 梅国华[1] 蒋剑涛 顾文奇[1] 陈城 施忠民[1] Su Yan;Li Zhendong;Xue Jianfeng;Zou Jian;Mei Guohua;Jiang Jiantao;Gu Wenqi;Chen Cheng;Shi Zhongmin(Department of Orthopedics,Affiliated Sixth People's Hospital,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤杂志》2020年第4期315-320,共6页Chinese Journal of Trauma

基　　金：国家科技部重点研发计划(2018YFC2001500);上海市“科技创新行动计划”生物医药领域科技支撑项目(19441902400);上海市“国内科技合作领域和长三角科技联合攻关领域”项目(18495800600);上海交通大学“医工交叉研究基金”(YG2017MS11)。

摘　　要：目的探讨经腓骨截骨复位内固定治疗中老年累及后踝陈旧性踝关节骨折的临床疗效。方法采用回顾性病例系列研究分析2013年7月—2018年3月上海交通大学附属第六人民医院收治的13例中老年累及后踝陈旧性踝关节骨折患者临床资料,其中男2例,女11例;年龄48~63岁,平均54.8岁。受伤至手术时间为8~18周,平均9.6周。后踝骨折根据Haraguchi分型,均为Ⅰ型。踝关节骨折根据Lauge-Hansen分型:旋前-外旋型2例,旋后-外旋型11例。均行经腓骨截骨复位内固定术。记录骨折愈合时间,观察术后并发症情况。末次随访时采用视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分评估临床效果。结果患者均获随访9~36个月,平均20.3个月。患者均获骨性愈合,愈合时间为12~15周,平均14.8周。患者术后无感染、内固定松动或断裂。1例患者X线片提示轻度创伤性关节炎。末次随访时VAS[(1.0±0.2)分]较术前[(5.3±0.6)分]明显下降(P<0.05)。末次随访时AOFAS踝-后足评分[(85.2±7.4)分]较术前[(42.4±6.7)分]明显升高(P<0.05),其中优4例,良8例,可1例,优良率为92%。结论经腓骨截骨复位内固定治疗中老年累及后踝陈旧性踝关节骨折,可以减少术后并发症,明显促进骨折愈合,减轻疼痛,改善踝关节功能。Objective To evaluate the clinical results of reduction and fixation via fibular osteotomy for treatment of old ankle fractures involving the posterior malleolus in middle-aged and elderly patients.Methods A retrospective case series study was made for 13 middle-aged and elderly patients with old ankle fractures involving the posterior malleolus treated from July 2013 to March 2018 in Sixth People\s Hospital Affiliated to Shanghai Jiao Tong University.There were 2 males and 11 females,with age of 48-63 years(mean,54.8 years).The mean surgical period was 8-18 weeks from injury(mean,9-6 weeks).According to Haraguchi classification,all posterior malleolar fractures were type I.According to Lauge-Hansen classification,there were 2 patients with pronation-external rotation type and 11 with supination-external rotation type.All patients underwent open reduction and fixation via fibular osteotomy.Bone healing time and postoperative complications were recorded.Clinical results were assessed by visual analogue scale(VAS)score and American orthopedic foot and ankle society(AOFAS)ankle-hind score.Results All patients were followed up for average 20.3 months(range,9-36 months).All patients had bone union,with the mean healing period of 12-15 weeks(average 14.8 weeks).No infection,implant loosening or breakage occurred after operation.X-ray film of one patient suggested mild traumatic arthritis.At the latest follow-up,VAS was improved to(1.0±0.2)points compared to pre-operative(5.3±0.6)points(P<0.05),and the AOFAS ankle-hind score was improved to(85.2±7.4)points compared to pre-operative(42.4±6.7)points(P<0.05).According to the AOFAS ankle-hind score,the results were excellent in 4 patients,good in 8,moderate in 1,with the excellent and good rate of 92%.Conclusion For old ankle fractures involving the posterior malleolus in the middle-aged and elderly patients,reduction and fixation via fibular can reduce postoperative complications,facilitate bone healing,relieve ankle pain and improve function recovery.

关 键 词：踝损伤 骨折固定术 内 截骨术 后踝 

分 类 号：R687.3[医药卫生—骨科学]