三踝骨折手术临床分析

目的探讨三踝骨折的手术治疗及疗效。方法对1998-2005年共42例三踝骨折病人施行手术治疗。手术中暴露顺序为内踝-外踝-后踝，内固定顺序为后踝-外踝-内踝，外踝予钢板螺钉内固定，后踝及内踝予加压螺钉内固定。术后功能锻炼，并根据症状及X线检查结果综合评定踝关节功能。结果全部病历均获得随访，随访时间为6～24个月，平均14个月。踝关节功能优者14例，良20例，可3例，差5例，优良率达80．9％。结论三踝骨折早期解剖复位可靠内固定，早期功能锻炼可取得优良的功能恢复。其中外踝骨折处理是关键。延期手术、严重骨质疏松以及严重踝关节周围软组织缺损者疗效差，易出现创伤性关节炎、关节僵硬等并发症。

Clinical Analysis of Tri-ankle Fractures Surgery

[ Objective] To analyze the effect of tri-ankle fractures surgery. [ Methods]42 cases of tri-ankle fractures were operated from 1998 to 2005. Medial, lateral and posterior ankles were incised and exposed consecutively, as to internal fixation it came to posterior, lateral and medial ankles. Plates and screws were employed for lateral ankles, and rag screws for medial and posterior ankles during the procedures. The function of the ankle joints was evaluated according to the clinical signs and X-ray examinations. [ Results] All cases were followed up for 6 to 24 months. The function of the ankle joints was excellent in 14 cases, good in 20, fair in 3 and bad in 5 cases. The excellent rate is 80.9%. [ Conclusion] Early anatomical reduction, rigid internal fixation and early exercise contribute to good functional recovery of the ankle joints, while the key to the procedure is the treatment of the lateral ankle. Complications such as traumatic arthritis and hardness occur in those cases with delayed surgical management, serious osteoporosis and bad soft tissue conditions.