手术治疗踝关节骨折的临床研究

目的 探讨踝关节骨折手术治疗及术后康复的效果。方法 本组120例踝关节骨折，男68例，女52例；年龄18～72岁，平均26．8岁。受伤肢体左侧55例，右侧65例，其中单纯内踝骨折8例，单纯外踝骨折21例，双踝骨折58例，三踝骨折33例。按Danis—Weber分类，A型8例，B型78例，C型34例。对内踝骨折复位采用全螺纹松质骨螺钉及张力带固定；外踝骨折行纯钛金属板螺钉内固定；对于后踝骨折，大于关节面1／4时，从前方置入4．5mm加压螺钉固定。手术的标准是肉眼下解剖复位。术后进行规范的功能锻炼，且不使用石膏外固定。结果 随访6～12个月，113例(94．2％)达到完全正常行走，7例(5．8％)行走时仍有小腿酸胀和踝部不适感。患者满意116例，满意率高达96．7％。结论 完好的复位、稳定的内固定及积极的术后康复可使大多数踝关节骨折患者恢复踝关节的正常功能。

Clinical study of surgical treatment for ankle fractures

Objective To explore the surgical treatment of ankle fractures and observe the postoperative rehabilitation. Methods Of 120 cases (68 males and 52 females, age range 18-72 years, average 26.8 years), there were 55 cases with injury on the left ankle and 65 on the right. Eight cases had only medial malleolus fracture, 21 pure lateral malleolus fracture, 58 bimalleolar fracture and 33 trimalleolar fracture.According to Danis-weber's classification, there were eight cases belonging to type A, 78 type B and 34 type C. The lag cancellous screw and tension band were used for medial malleolus and the pure titanic plate and screw for lateral malleolus fractures. The compression screw for 4.5 mm was inserted from anterior part to fixate the posterior malleolus fractures with defects bigger than 1/4 of the joint surface. The criterion was anatomic reduction under naked eyes. Postoperative function exercise was performed with no plaster for external fixation. Results A followed up for 6-12 months showed that 113 cases (94.2%) could walk as normal, 7 (5.8%) felt ache at the culf and uncomfortable at the ankle when walking and 116 satisfied with the results with satisfaction rate of 96.7%. Conclusions Exact reduction,stable internal fixation and active postoperative rehabilitation can help the joint recover to normal function in most cases with ankle fractures.