儿童浮踝损伤一例报道  

Floating ankle injury in children:one case report

作　　者：于铁强[1] 左玉明[1] 廉小婧 刘洪达[1] YU Tie-qiang;ZUO Yu-ming;LIAN Xiao-jing;LIU Hong-da(Department of Pediatric Orthopaedics,The Second Hospital of Tangshan,Tangshan,Hebei,063000,China)

机构地区：[1]唐山市第二医院小儿骨一科,河北省063000

出　　处：《中国骨与关节杂志》2025年第4期382-384,共3页Chinese Journal of Bone and Joint

摘　　要：胫腓骨骨折是儿童常见骨折之一,约6%存在合并损伤。McHale等^([1])在2002年首先报道浮踝损伤,指胫骨下段骨折伴同侧足部骨折,而踝关节完整。此损伤本身罕见,发生于儿童则更为罕见,以往的文献中只见报道13例,其中儿童仅1例^([1])。未见中文文献报道。2015年我科收治1例,报道如下。临床资料患儿,男,9岁1个月,因押运车撞伤致右小腿、右足疼痛,右小腿出血3 h于2015年12月2日入院。查体:右小腿畸形,中下段后外侧见直径约2.5 cm伤口,腓骨骨折端外露,无活动性出血,右小腿中下段、踝及足背明显肿胀,足跟可见瘀斑。右胫腓骨下段及跟骨压痛,可触及骨擦感及异常活动。右足背动脉搏动未触及,多普勒可测及,足趾点压回血存在。Objective To report a case of floating ankle injury in a child,and summarize the treatment experience.Methods In December 2015,a 9-year-old boy with open fracture(type GustiloⅡ)of the right distal of the tibia and fibula with ipsilateral calcaneus fracture caused by a traffic accident was admitted.In the emergency department,debridement,anastomosis of the peroneus longus and brevis muscles,manual reduction of the fracture and plaster fixation were performed under nerve block anesthesia.Limited open reduction plate fixation of the right tibial fracture was performed under general anesthesia on December 18,2015.Due to obvious shortening of the fracture end,the fibula shortened after the reduction of the tibia.The plate was removed on November 14,2016.In March 2017,the tibia fractured again due to trauma and was treated with plaster fixation.Results The postoperative followed-up was 8 years and 2 months.The tibial fracture unioned 4 months after surgery.The calcaneal fracture was completely remodeled 11 months after the injury.The X-ray films showed that the fibula was gradually shortened and the medial space of the ankle joint was widened.The AOFAS score was 95 points.Conclusions Floating ankle injuries are mostly high-energy injuries,with serious soft tissue damage.For open fractures,external fixators are recommended to restore the length of the fracture.The distal tibiofibular syndesmosis should be observed when the fibula is shortened,and the fibula should be reduced and fixed when the distal tibiofibular dissociation occurs.Extra-articular calcaneal fracture remolding has greater potential for kids under 10 years old.

关 键 词：胫骨骨折 跟骨 儿童 浮踝损伤 

分 类 号：R684.7[医药卫生—骨科学]