踝关节严重骨折及脱位的修复重建

目的 总结踝关节严重骨折及脱位的手术方法及临床疗效.方法 2003年3月-2006年2月,采用一期骨折切开复位、经皮钢板内固定治疗76例踝关节严重骨折及脱位患者.男47例,女29例;年龄18～65岁,平均36.4岁.根据AO分型C3-1型13例,C3-2型45例,C3-3型18例.23例开放骨折按Gustilo-Anderson分型Ⅱ型17例,ⅡⅢA型6例.均为新鲜骨折,伤后至手术时间1～24 h.结果 术后4例伤口浅表感染,经对症处理后痊愈;其余伤口均Ⅰ期愈合.72例获随访12～35个月,平均18.5个月.骨折愈合时间为12～24周.2例分别于术后16、20周复诊时发现固定下胫腓关节的螺钉断裂,术后1年取出内固定;28例于术后12周单独取出固定下胫腓关节的螺钉;余患者均于术后1年完整取出内固定.术后患者踝关节活动范围背伸21.7～26.8°,屈曲38.5～44.7°按美国足踝外科评分系统评定疗效,优23例,良36例,中13例,优良率81.94%.结论 手法恢复踝关节力线,及时切开减张复位,结合微创经皮钢板内固定技术修复重建踝关节严重骨折及脱位,可获满意疗效.

REPAIR AND RECONSTRUCTION FOR SEVERE FRACTURE AND DISLOCATION OF ANKLE JOINT

OBJECTIVE: To summarize the technique and effect of the therapy for severe fracture and dislocation of ankle joint by operation. METHODS: From March 2003 to February 2006, 76 cases were treated with primary open restoration and internal fixation for dislocated ankle joint fracture, with 47 males and 29 females, with the average age of 36.4 years (ranging from 18 years to 65 years). According to AO criterion, these fresh fractures were classified into 13 cases for type C3-1, 45 cases for type C3-2 and 18 cases for type C3-3. Based on the Gustilo-Anderson standard, 23 open fractures were classified into 17 cases for type II and 6 cases for type III A. The operation was delayed from 1 hours to 24 hours after the injury. RESULTS: All incisions healed at the first stage except 4 cases which delayed union because of simple infection by revision with ointment. A total of 72 cases were followed up, with the average time of 18.5 months (from 12 months to 35 months). The time of bone union was from 12 weeks to 24 weeks. The screws of fixation for lower tibia-fibula joint were found to be ruptured in 2 cases when further consultation was performed in the 16th and 20th week after the operation, respectively, and were broken within 1 year after the operation. These screws were taken out 12 weeks postoperative in 28 cases, while the whole internal fixations of the rest cases were taken out 1 year after the operation. The postoperative function of malleolus extended from 21.7 degrees to 26.8 degrees and flection from 38.5 degrees to 44.7 degrees. Assessed by the American Orthopaedic Foot and Ankle Society Clinical Rating Scales, 23 cases were excellent, 36 good, 13 fair, and the choiceness rate reached 81.94%. CONCLUSION: These procedures, together with reduction by twist after hospital, open and internal fixation in time, and parenchyma managed with internal fixation, are important to attain satisfactory effect for the treatment of severe fracture and dislocation of ankle joint.