闭合性Danis—WeberB和C型三踝骨折的手术疗效分析

目的探讨闭合性Danis—WeberB和C型三踝骨折的最佳手术时机及固定后踝骨折块对踝关节功能恢复的影响。方法对2008年11月至2011年11月接受手术治疗的61例Danis—WeberB和C型三踝骨折患者进行回顾性研究．其中男性38例，女性23例：年龄18～68岁，平均年龄43岁。分为急诊手术组（A组）28例，择期手术组（B组）33例，对两组手术时间、骨折愈合时间、切口愈合时间、并发症及Baird-Jackson踝关节评分标准进行比较；根据后踝骨折块固定与否将患者分成后踝骨折固定组（C组．26例）和后踝未固定组（D组，35例），对两组术后疗效及需行下胫腓固定患者的比例进行比较。结果61例患者术后获得1～3年（平均随访时间1．7年）随访，在手术时间上A组明显少于B组[（102．50±10．13）min vs（146．80±11．73）min]，而在骨折愈合时间和并发症发生率上差异无统计学意义（P〉0．05）。按Baird—Jackson踝关节评分系统：C、D两组优良率分别为76．92％和65．71％，差异无统计学意义（P〉0．05）。结论对于多数闭合性Danis—WeberB和C型三踝骨折．早期手术安全有效．固定后踝骨折块对重建踝关节稳定性及踝关节功能恢复具有重要的意义。

Analysis of surgical effect of closed Danis - Weber B and C type trimalleolu fractures

Objective To discuss the optimal surgery timing of closed Danis-Weber B and C type tfimalleolus fractures and the influence of after ankle fracture fragment on the fixation ankle function restoration. Methods A retrospective review was performed on those who received surgical treatment of closed Danis-Weber B and C type trimalleolus fractures from November 2008 to November 2011, there were a total of 61 patients, included 38 males and 23 females, who were aged 18 - 68 years old with a mean age of 43. All of them were divided into the emergency surgery group （group A, n = 28） and elective surgery group （group B, n = 33）. The operation time, fracture healing time, incision healing time, complications and Baird-Jackson ankle evaluation standard were compared between 2 groups. Accorded to whether the after ankle fracture fragment was fixed or not, the patients were divided into ankle fracture fixation group（group C, n = 26） and non-fixation group（group D, n = 35）. The curative effect and rate of requiring tibial phil fixation between 2 groups were compared. Results A total of 61 cases were followed up from 1-year to 3-year（mean 1.7-year）. Group A was less than group B in operation time[（102.50 ± 10.13） minutes vs （146.80 ± 11.73） minutes], and there was no significant difference in fracture healing time and complications between 2 groups（P 〉 0.05）. Accorded to the Baird-Jackson score system, the total rate of good results was 76.92 % and 65.71% in group C and group D, respectively（P 〉 0.05）. Conclusion It is demonstrated that performing operation for the closed Danis-Weber B and C type trimalleolus fractures at early stages is safe and effective, and after ankle fracture fragment fixation has great significance in rebuilding ankle stability and ankle function restoration.