腓骨复位不良矫正术治疗踝关节骨折术后创伤性关节炎  

Treatment of late Complications Traumatic Osteoarthritis Due to Fibular mal-reduction after Open Reduction and internal Fixation of Ankle Fracture

作　　者：胡争波 李文虎 蓝文兴 魏啸 黎路根 温湘源 袁艾东 HU Zheng-bo;LI Wen-hu;LAN Wen-xing(Department of traumatic orthopedics,Shaoguan affiliated hospital of Nanfan medical university,Shaoguang 512000)

机构地区：[1]南方医科大学附属韶关医院一韶关市第一人民医院骨科,广东韶关512000

出　　处：《中国伤残医学》2021年第16期1-4,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探讨手术矫正腓骨复位不良治疗踝关节骨折切开复位内固定(ORIF)术后创伤性关节炎的临床疗效。方法:采用回顾性病例系列研究分析南方医科大学附属韶关医院2010年1月-2020年1月收治的37例踝关节骨折ORIF术后因腓骨复位不良导致中度创伤性关节炎患者临床资料,其中男17例,女20例;年龄21-67岁(46.2±14.3)岁。按术前踝关节骨折Lauge-Hansen分型:旋后-内收型3例,旋后-外旋型8例,旋前-外展型7例,旋前-外旋型19例(其中Maisonneuve骨折8例)。单纯创伤性关节炎18例,合并踝关节不稳6例、关节撞击综合征4例、关节僵硬4例、关节畸形3例和内固定断裂2例。治疗采用单纯腓骨复位不良矫正手术28例,结合关节镜手术3例、韧带修复重建手术2例。记录骨折愈合时间,比较术前术后踝关节视觉模拟评分(VAS)、踝关节活动度、胫距关节间隙及美国足踝外科协会(AOFAS)踝-后足功能评分,观察并发症情况。结果:患者均获随访时间38-67(47.6±8.2)个月。术前踝关节VAS为(5.6±1.1)分,术后1,2,3年分别为(3.2±1.1)分、(2.1±0.6)分、(1.2±1.0)分(P<0.01)。术前踝关节屈伸活动度为35.5°±5.8°,术后1,2,3年分别为50.2°±10.5°、57.2°±6.6°、67.20±6.3°(P<0.01)。术前内外翻活动度为21.5°±6.6°,术后1,2,3年分别为40.4°±6.5°、48.5°±4.3°、52.4°±5.1°(P<0.01)。术前、术后3年踝关节胫距间隙分别为(1.9±0.7)mm、(2.0±0.5)mm,间距增加但差异无统计学意义(P>0.05)。术前AOFAS踝-后足功能评分为(52.4±11.2)分,术后1,2,3年分别为(72.4±9.1)分、(80.3±6.2)分、(86.4±5.9)分(P<0.01);其中优20例,良13例,可3例,差1例,优良率为89%;骨折愈合时间12-20(12.9±3.5)周;并发症包括踝关节不稳1例,伤口愈合不良2例,创伤性关节炎1例。结论:手术矫正腓骨复位不良是治疗踝关节骨折ORIF术后创伤性关节炎的必要手段,可持续减轻疼痛、增加踝关节活动度、增加踝关节胫距Objective:To study operation surgery effect of late complications medium traumatic osteoarthritis due to fibular mal-reduction after open reduction and intermal fixation(ORIF)of ankle fracture.Methods:From January 2010 to January 2019,A retrospective analysis was made.37 patients were hospitalized for late complications due to poor fibular reduction after ORIF operation of ankle fracture in the department of traumatic orthopedics,including 17 males and 20 females,aged 21-67 years with an average age of 46.2±14.3.There were 18 cases of traumatic osteoarthritis(TOA)alone,and 6 cases of TOA with ankle instability,4 cases of TOA with joint impact syndrome,4 cases of TAO with joint stiffness,3 cases of TAO with joint deformity and 2 cases of TAO with internal fixation fracture.28 cases were treated alone with fibular reduction and fixation,3 added with arthroscopy and 2 added with ligament reconstruction.The visual analogue(VAS)score,ankle mobility,joint space and ankle posterior foot function of American Association of foot and ankle orthopedics before and after treatment were compared.The average clinical healing time of bone and complications were also observed.Results:All cases were followed up for47.6±8.2 months.The average clinical healing time of bone was 12.9±3.5 weeks.Before the operation,the VAS score of ankle pain was(5.6±1.1),and lyear,lyears and 3 years after operation,it was(3.2±1.1),(2.1±0.6),(1.2±1.0),respectively.The difference was statistically significant(P<0.01).The range of flexion and extension of ankle joint was(35.5±5.8)and(50.2±10.5),(57.2±6.6),(67.2±6.3).The difference was statistically significant(P<0.01).The activity of eversionis(21.5±6.6),and(40.4±6.5),(48.5±4.3),(52.4±5.1),the difference was statistically significant(F=214.5,P<0.01).The AOFAS score was(52.4±11.2)and(72.4±9.1),(80.3±6.2),(86.4±5.9).The difference was statistically significant(P<0.01).The tibiotalar space of ankle joint was 1.9±0.7 and2.0±0.5 before and 3 years after operation,the difference was no sta

关 键 词：踝关节骨折 切开复位内固定 创伤性关节炎 

分 类 号：R683.42[医药卫生—骨科学]