郑氏伤科手法辅助跟腱旁改良入路治疗后踝骨折临床疗效分析  

Clinicalefficacy analysis of Zheng's traumatology manipulation-assisted modified approach to the treatment of posterior ankle fracture

作　　者：刘然 彭亮[1] 李萍萍 魏国华[1] 巫宗德 张强[1] 刘亮[1] LIU Ran;PENG Liang;LI Pingping(Department of Foot and Ankle,Sichuan Orthopedic Hospital,Chengdu Sichuan610041,China)

机构地区：[1]四川省骨科医院足踝科,四川成都610041

出　　处：《四川中医》2023年第3期197-200,共4页Journal of Sichuan of Traditional Chinese Medicine

摘　　要：目的:通过对郑氏伤科手法辅助跟腱旁改良入路治疗后踝骨折临床观察,探讨其优势。方法:2017年3月~2020年10月期间,收集94例在四川省骨科医院住院的后踝骨折移位且运用郑氏伤科手法辅助跟腱旁改良入路治疗后踝骨折患者,根据Bartonicek分型[2]进行分型,其中Ⅱ型:41例(43.6%);Ⅲ型24例(25.5%);Ⅳ型:29例(30.9%),收集患者住院期间基本情况、跟腱旁入路与联合入路的间隔距离、后踝骨间小骨复位情况、以及术后CT结果评估此入路对后踝骨折的复位效果及固定是否牢靠、术后并发症,收集末次AOFAS后足评分。结果:共收集完整随访资料94例,随访时间9月-21月,平均时间13.4±1.3月;94例患者达到临床愈合,均未出现术后骨位丢失、螺钉钢板松动或断裂等;术后未出现腓肠神经损伤,均无感染、皮肤坏死等情况发生。后踝复位情况:解剖复位84例(87.5%);复位良好8例(8.3%);对位一般2例(2.1%)。AOFAS踝与后足评分情况:92.40±2.28,其中优良率达94例(100%)。结论:通过郑氏正骨手法结合跟腱旁改良入路联合外踝上改良切口、或者内侧切口处理后踝BartonicekⅡ、Ⅲ、Ⅳ骨折,能有效复位的同时很好地兼顾下胫腓联合的复位固定,恢复踝关节冠状面踝穴连续性以及横截面下胫腓联合的匹配度、矢状面胫骨远端连续性;能直观的安置内固定物,避免内固定物松动,能避免部分的腓骨肌腱刺激等并发症,术后结果优良,是治疗后踝入路的选择之一。Objective To explore the advantages of Zheng's Traumatology Manipulation in the treatment of posterior malleolus fractures through the clinical observation of the modified approach near Achilles tendon.Methods:from 2017to 2020,94patients underwent reduction and internal fixation of posterior ankle fracture by combined with modified approach near Achilles tendon in Zheng's Department of traumatology.According to Bartonicek classification[2],there were 41cases(43.6%)of typeⅡ,24cases(25.5%)of typeⅢ;The basic information of the patients during hospitalization,the distance between the paratenon approach and the combined approach,the repositioning of the small bones between the posterior ankle bones,and the postoperative CT findings were collected to assess the effect of this approach on the repositioning of the posterior ankle fracture and The post-operative CT findings were used to assess the effectiveness of this approach in the repositioning of the posterior ankle fracture and the reliability of fixation,post-operative complications,and to collect the last AOFAS hindfoot score.Results:a total of 94patients were followed up from 9months to 21months,with an average of 13.4±1.3months.;Clinical healing was achieved in 94patients,with no postoperative bone loss,screw plate loosening or fracture in any of them;there was no postoperative peroneal nerve injury,and no infection or skin necrosis occurred.Anatomical repositioning in 84cases(87.5%);good repositioning in 8cases(8.3%);fair alignment in 2cases(2.1%).The AOFAS ankle and hindfoot score:92.40±2.28points,of which 94cases were excellent(100%).Conclusion:Zheng's Department of traumatology combined with the improved approach near the Achilles tendon can effectively reduce the fractures of the posterior ankle.At the same time,it can give good consideration to the reduction and fixation of the lower tibiofibular joint;It can intuitively place the internal fixation,avoid the loosening of the internal fixation,and avoid some complications such as fibular tendon stimul

关 键 词：郑氏伤科手法 手术入路 后踝骨折 后踝分型 

分 类 号：R274.12[医药卫生—中医骨伤科学]