踝关节骨折脱位的治疗

目的 总结踝关节骨折脱位治疗的经验。方法 对1987～1997年103例踝关节骨折脱位治疗情况进行分析,随访6个月～5年,平均2年3个月。采用Weber评分标准评定临床疗效。结果 手术治疗38例:优13例(34.2％),良18例(47.4％),差7例(18.4％),优良率占81.6％。其中单纯外踝骨折14例仅14.3％(2/14)获得解剖复位,临床疗效优良率达92.8％。手术治疗65例:优34例(52.3％),良23例(35.4％),差8例(12.3％),优良率占87.7％。其中单纯外踝骨折18例,83.3％(15/18)获解剖复位,疗效优良率为94.4％。合并下胫腓关节分离31例。术中没有行下胫腓联合固定20例,80％(16/20)未发现有踝穴增宽,4例下胫腓关节有轻中度分离,疗效差。结论 (1)目前广泛应用的分类方法,没有一个可用来判断预后,踝关节损伤的分类还需要进一步完善;(2)单纯外踝骨折,保守治疗可获满意疗效,手术比保守治疗并无优势;(3)合并下胫腓联合损伤时,只要内、外踝及腓骨骨折准确对位,固定牢固,不需固定下胫腓联合。

The Treatment of Ankle Joint Fracture and Dislocation

Objective To sum up the experience of treatment of fracture and dislocation of ankle joint.Methods From 1987 to 1997, 103 cases with fracture and dislocation of ankle joint, which treatment condition had been analyzed, followed up from 6 months to 5 years, (the average is 2 years and 3 months) . Acceding to Weber grading standard assessed their clinical results of treatment. Results Among 38 cases in manual treatment, there were excellent results in 13 cases (34. 2% ), good results in 18 cases (47. 4% ) and poor results in 7 cases (18. 4% ) . Excellent and good were 81. 6%. There were 14 cases with fracture of simple lateral malleolar, only 14.3% (2/14) obtained anatomic restoration. Clinical results of treatment: excellent and good were 92. 8%. A-mong the 65 cases which had been operated, 34 cases (52. 3% ) were excellent, 23 cases (35. 4% ) were good and 8 cases (12. 3% ) were poor, excellent and good were 87. 7%. There were 18 cases with fracture of simple lateral malleolar, 83.3% (15/18) obtained anatomic restoration, clinical treatment results of treatment: excellent and good were 94. 4%. 31 cases accompanied with separation of syndesmosis tibiofibularis joint. It had not fixed in 20 operation cases. No increasing the broad of ankle joint had been found in 80% (16/20) cases. There were 4 cases with sliglt or middle separation of syndesmosis tibiofibularis joint, and clinical results of treatment were poor. Conclusion (1) There was no method which could diagnosticate prognosis in persent widely apply classification methods. The classification of injury of ankle joint should be further perfet. (2) The fra,cture of simple lateral malleolar may obtain satisfactory results with conservative treatment. We compared the Surgery operation with the conservative treatment and found the surgery operation has not superiority. (3) In cases with injury syndesmosis tibiofibularis, provided interal malleolus and lateral malleolus correct restoration, fixation and fastness, do not require to fix the syndesmosis tibiofibularis.