外旋型踝关节骨折中后踝的治疗

目的：总结踝关节骨折中后踝的诊断、手术方法，阐述后踝骨折复位固定的重要性。方法：2004年1月至2008年1月手术治疗的踝关节外旋型骨折合并后踝骨折患者25例，男17例，女8例；年龄21-67岁，平均34岁。按Lauge—Hansen分型，旋前外旋型Ⅳ型13例，旋后外旋型Ⅲ型7例、Ⅳ型5例。后踝骨折中20例采用螺钉内固定，5例采用石膏外固定。术后用X线即时评估标准观察手术复位效果。结果：随访时间为7～36个月，平均15个月，按Leeds临床评定标准进行评定，优21例，良2例，差2例。对踝关节作活动范围的评估并与健侧比较，两者在背伸、跖屈方面无明显差异。结论：良好的复位、固定，以及后踝正确处理是恢复踝关节正常功能的保证。

Surgical treatment for posterior malleolus fracture of external rotation

Objective：To evaluate a surgical technique and outcome and illustrate its important of open reduction and internal fixation for fractures of posterior malleolus. Methods： From Jan. 2004 to Jan. 2008,25 cases were treated with open reduction and internal fixation involving 17 males and 8 females with an average age of 34 years （ranged from 21 to 67 years old）. According to Lauge-Hansen classification： 13 cases of type pronation-external rotation （Ⅳ）, 7 and 5 cases of type supinationexternal rotation （Ⅲ and Ⅳ ）. Twenty cases were treated with screw, 5 cases were treated with gypsum. To evaluate the outcome of operation with X-ray. Results： After seven months to three years followed-up, clinic therapeutic effect of each patient was evaluated according to the Leeds scoring system ,the results were excellent in 21 cases and good in 2. As compared with the uninjured side on the evaluation of the activity range of ankle joint, there were no significant difference in back-extend and plantar flexion. Conclusion：In order to obtain ankle joint satisfactory result, open reduction and rigid internal fixation must be adopted in the fracture of posterior malleolus.