手术与保守治疗对踝关节骨折疗效的影响

目的比较手术与保守治疗对较严重踝关节骨折的疗效。方法将86例较严重踝关节骨折患者分成手术组(49例)与保守组(37例),并进行24个月的随访,统计2组患者关节功能的恢复情况,并评价效果。结果对于踝关节骨折较严重患者,特别是出现韧带断裂与骨折移位现象,手术治疗对关节功能恢复的效果较保守治疗的效果好(P<0.05),差异有统计学意义。结论骨折的严重程度不同,选择的方式有所差异,但当骨折己发生移位后,最好采用手术对移位区域进行完全复位。     

踝关节外侧副韧带损伤的手术治疗

踝关节内翻应力时极易造成踝外侧副韧带损伤,漏诊率高,大多采用保守治疗,但对于Ⅲ度损伤的患者,通过外固定治疗易产生踝关节外侧不稳.我院自2007年3月至2009年4月对11例踝关节外侧副韧带Ⅲ度损伤患者进行了早期手术修复,现报告如下.     

Pilon骨折的治疗

目的探讨P ilon骨折治疗方法的选择和注意事项。方法对58例P lion骨折分别采用保守治疗和手术治疗。结果按照M azur制定的踝关节症状与功能系统进行评估,优37例、良15例、可4例、差2例。结论Ⅰ型和部分移位小于2 mm的Ⅱ型骨折应采用保守治疗;移位大于2 mm的Ⅱ型骨折和Ⅲ型骨折应积极手术治疗。     

踝关节骨折中腓骨骨折的诊疗进展北大核心CSCD

目的总结踝关节骨折中腓骨骨折的诊断及治疗进展。方法广泛查阅近年国内外相关文献,并依据Danis-Weber分型对各型骨折进行讨论总结。结果保守治疗对于A型腓骨撕脱骨折并非理想治疗方式,手术方式需要根据骨折块位置、大小决定;对于单纯B型骨折,无论保守治疗还是手术治疗都能取得较为不错的结果;当C型骨折位置较高、不影响踝关节稳定时可进行保守治疗,而当位置较低影响踝关节稳定时,需手术治疗。结论对于踝关节骨折中腓骨骨折,首先应明确骨折是否为稳定骨折,无论是否手术治疗,目的都在于恢复踝关节下胫腓联合关系及踝关节运动功能。     

踝关节骨折56例治疗探讨

目的探讨不同类型踝关节骨折的治疗方法、手术时机及预后,提高临床治疗效果。方法分析56例踝关节骨折的手术时机、治疗方法以及预后的情况,比较不同类型的踝关节骨折预后情况。结果骨折愈合时间8～14周,愈合效果优良率达97.06%,有2.94%效果不佳。结论对新鲜踝关节骨折如保守治疗达不到解剖复位,应尽早手术以恢复踝关节的完整性。     

慢性踝关节外侧不稳手术适应证的现状

慢性踝关节外侧不稳在临床十分常见,以反复踝关节扭伤、局部疼痛为主要表现,但手术适应证争议较大。为此,本研究搜索了Pubmed、Web of Science、The Cochrane Library以及中国生物医学文献数据库、维普信息资源系统数据库。对文献进行全面分析,发现大多数手术医生容易接受的手术适应证为:(1)具有踝关节反复扭伤或者疼痛等不稳症状,保守治疗3~6个月后仍存在症状;(2)通过前抽屉试验或者距骨倾斜试验、或者应力位摄X线片、或者磁共振MRI检查,提示存在踝关节机械性不稳的表现。本文对此现状进行全面综述,为规范化临床治疗提供依据。     

踝关节骨折56例治疗探讨

目的探讨不同类型踝关节骨折的治疗方法、手术时机及预后,提高临床治疗效果。方法分析56例踝关节骨折的手术时机、治疗方法以及预后的情况,比较不同类型的踝关节骨折预后情况。结果骨折愈合时间8～14周,愈合效果优良率达97.06%,有2.94%效果不佳。结论对新鲜踝关节骨折如保守治疗达不到解剖复位,应尽早手术以恢复踝关节的完整性。     

Maisonneuve骨折临床分析及相关实验研究

目的 探讨Ｍａｉｓｏｎｎｅｕｖｅ骨折（ＭＦＦ）创伤机制及临床治疗方法。方法 ＭＦＦ患者１９例,８例行保守治疗,１１行手术治疗,８例术前行ＭＲＩ检查;平均随访时间１６．８个月,另外取新鲜尸体大腿截肢标本进行截骨及骨间膜顺序切断实验,观察踝关节应力像表现。结果 （１）踝关节功能恢复情况;１１例手术患者中８例良好,３例可;８例保守治疗患者中３例良好,３例可,２例差;（２）ＭＲＩ检查结果,骨间膜损伤水平在     

踝关节镜前后联合入路治疗踝关节撞击综合征

目的 :分析踝关节镜前后联合入路对踝关节撞击综合症患者镜下行清理的临床疗效及术中注意事项。方法:回顾性分析自2011年4月至2015年4月采用踝关节镜治疗并获得完整随访的17例踝关节撞击综合症患者,其中男12例,女5例;手术时年龄22~47岁,平均32.4岁。结合患者临床症状和影像学评估予踝关节镜清理,并去除引起症状的撞击部位,术后常规予非甾体消炎药和关节内注射透明质酸钠治疗。采用AOFAS(美国足踝外科协会)后足-踝评分,Ogilvie-Harris踝关节评分对术前情况及术后末次随访情况进行评分。结果:17例手术中情况:关节镜下显示前外踝撞击征8例,前内踝撞击征2例,前踝撞击征2例,后踝撞击征2例,3例为同时合并前后踝撞击。术中清除增生的骨赘,引起撞击的下胫腓前韧带远侧束,距腓前韧带,滑膜组织和疤痕组织。4例同时合并关节软骨损伤,软骨损伤面积约1 mm×3 mm至1.5 mm×4 mm大小。术中同时采用直径1.2 mm的克氏针行钻孔微骨折处理。17例术后随访时间8~24个月,平均14.3个月。AOFAS评分由手术前的62.30±5.20增加至术后的87.60±5.40。Ogilvie-Harris踝关节评分由手术前的6.70±0.98增加至术后的12.80±1.21。术后患者均无神经血管损伤,无伤口感染,愈合不良等并发症。患者有不同程度的踝关节肿胀,于术后4~8周逐步消失。结论:对踝关节撞击综合症患者,前后联合入路可以有效清除引起踝关节撞击的骨性撞击和软组织撞击,结合术后非甾体消炎药和关节内注射透明质酸钠治疗,可以有效缓解踝痛症状,达到较好的治疗效果。     

踝关节外伤性腓总神经卡压综合征的治疗

目的探讨踝关节外伤性腓总神经卡压综合征的发生机制及治疗效果。方法对16例踝关节外伤性腓总神经卡压综合征进行综合治疗,其中11例保守治疗,5例进行手术治疗,术中发现腓总神经有不同程度的水肿、黏连,色泽苍白或暗淡,外膜增厚。结果本组均获随访,随访时间8个月～6年,平均4年。观察双下肢胫骨前肌、腓骨长短肌、伸足母长肌及伸趾长肌等肌力及小腿外侧、足背皮肤感觉恢复情况。16例患者腓总神经损伤的功能有不同程度恢复,其中优10例,良4例,可1例,差1例。结论对于踝关节损伤引起腓总神经卡压综合征予以保守治疗为主,但对于诊断完全性神经损伤保守治疗无效的患者及早行神经松解术,疗效比较满意。     

Arthroscopic treatment of anterior ankle impingement

Anterior ankle impingement is a common cause of chronic ankle pain in the athletic population. Its cause can be either soft tissue or osseous in nature. Arthroscopic debridement results in favorable and reproducible outcomes. However, in the population in which ankle instability or narrowing of the ankle joint occur, outcomes may be less favorable.     

Arthroscopic repair of lateral ankle instability by using the thermal-assisted capsular shift procedure: a review of 4 cases

The purpose of this study is to determine the preliminary effectiveness of the thermal-assisted capsular shift procedure for treatment of chronic lateral ankle instability. A retrospective preoperative evaluation using a modified American Orthopedic Foot and Ankle Society's ankle scoring system was performed on 4 patients treated with the procedure. Patients were then contacted for a 6-month follow-up evaluation using the same scale. The mean preoperative score was 26 of 60 and the mean postoperative score was 51 of 60, a mean 25-point improvement. All 4 rated their satisfaction with the surgery as good or excellent and 3 of 4 stated they would have the surgery again if necessary. The thermal-assisted capsular shift procedure showed good to excellent early results in this small study group and offers the foot and ankle surgeon a minimally invasive surgical alternative for treatment of lateral ankle ligament instability.     

Anterior tibiotalar impingement associated with chronic ankle instability

The authors describe the surgical treatment of 13 cases of chronic ankle instability and concomitant anterior bony impingement of the ankle in professional and recreational athletes. All patients had symptoms and signs of lateral instability and a painful block to dorsiflexion. Two patients presented with recurrence of impingement after a previous debridement alone without an ankle stabilization. The anterior osteophytes were debrided arthroscopically and a Brostrom-Gould open stabilization was performed. After a mean follow-up period of 12 months (range 4-23 months), all 13 patients had mechanically and functionally stable ankles. The mean improvement in range of dorsiflexion was 12.4 degrees and all but one had improvement with respect to a subjective and functional outcome assessment. There have been no recurrences of impingement to date. These results suggest that ankle stabilization performed in conjunction with debridement of osteophytes may reduce the recurrence of exostoses as well as improving the outcome.     

Lateral Ligament Reconstruction of the Ankle with a Modified Watson-Jones Operation

A modified Watson-Jones technique, using only half of the peroneus brevis tendon, was applied as an operative procedure for lateral ankle instability. Twenty-nine patients with 30 operated ankles were examined with an average follow-up period of 7 years and 6 months. Functional stability was achieved in all but one of the operated ankles. In 15 cases there were periodic pains and swelling on activity, while the remaining 14 ankles were without symptoms. Supination of the foot was slightly decreased in 4 cases.