外踝骨折合并三角韧带断裂一期手术治疗临床疗效观察

目的观察外踝解剖钢板内固定外踝骨折后同时采用带线锚钉缝合修复三角韧带断裂的临床疗效。方法回顾性分析自2016-08—2018-08诊治的16例外踝骨折合并三角韧带断裂,先作内侧踝关节弧形切口探查损伤的三角韧带,将嵌顿在踝关节间隙内的三角韧带断端牵出,标记三角韧带的浅层和深层。再作外踝纵形切口进行外踝骨折切开复位解剖钢板内固定,置入1枚空心钉稳定下胫腓联合,垂直距骨体中心部置入2枚Anchor带线锚钉缝合固定三角韧带深层,用2枚Anchor带线锚钉于内踝尖前部及下部缝合固定三角韧带浅层。结果 16例术后均获得随访,随访时间平均13.2(10～20)个月。随访期间外踝骨折愈合良好,无内固定失败、骨折不愈合、感染等并发症发生,前抽屉试验阴性,无距骨倾斜。末次随访时疼痛VAS评分、踝与后足功能AOFAS评分、内侧踝关节间隙较术前明显改善,差异有统计学意义(P0.05)。结论明确三角韧带断裂后一期行外踝骨折切开复位内固定与带线锚钉缝合修复三角韧带可以明显缩小内侧踝关节间隙,增加踝关节稳定性,减少因三角韧带损伤导致的踝关节不稳及其他并发症的发生。     

缝合锚钉治疗踝关节三角韧带附着点断裂疗效观察

目的评价缝合锚钉治疗踝关节三角韧带附着点断裂的临床疗效。方法采用锚钉系统治疗29例三角韧带附着点断裂患者,其中距骨附着点断裂24例,内踝附着点断裂5例。结果 29例均获得随访,时间9~26个月。踝关节功能采用美国足踝外科学会(AOFAS)踝-足评分标准评价:优17例,良10例,可2例,优良率27/29;按照改良Baird-Jackson评分系统评价:优17例,良9例,可3例,优良率为26/29。结论缝合锚钉治疗踝关节三角韧带附着点断裂,其有操作简便易行、可提供踝关节内侧即刻稳定性、利于韧带修复、疗效可靠等优点,是治疗三角韧带附着点断裂的有效方法。     

急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略

目的探讨丝攻试验对三角韧带损伤的诊断价值,比较跨下胫腓联合螺钉固定与锚钉缝合修复三角韧带的疗效。方法 2011年6月至2013年12月,对我院收治的51例疑有三角韧带损伤的踝关节骨折患者进行丝攻试验,并将阳性患者随机分为锚钉缝合修补三角韧带组(A组)和跨下胫腓联合螺钉固定组(B组)。采用美国足踝骨科学会(AOFAS)踝-后足评分和疼痛视觉模拟评分(VAS)评价术后疗效。结果最终45例患者纳入统计学分析。A组21例,B组24例。A组有19例获得随访,平均随访14个月;B组有23例获得随访,平均随访18个月。末次随访时,A、B组患者均获得骨性愈合。A组AOFAS踝-后足评分和VAS评分分别为(87.50±6.30)分和(1.79±1.47)分,B组AOFAS踝-后足评分和VAS评分分别为(85.20±7.54)分和(1.56±1.20)分。两组AOFAS踝-后足评分和VAS评分差异无统计学意义。B组复位不良率达34.8%,A组仅为5.26%。结论三角韧带的完整性是影响下胫腓联合分离和内侧踝穴增宽的重要因素,修补三角韧带与跨下胫腓联合螺钉固定疗效相当,但其复位不良率低,且无二次取钉及断钉等问题。丝攻试验对于三角韧带损伤诊断和手术效果评估具有重要价值。     

两种方式修复三角韧带完全断裂的病例对照研究

目的 :通过回顾性对照研究比较钻孔经骨道不可吸收缝线缝合法与锚钉缝合法用于修复三角韧带完全断裂的手术疗效。方法:2009年1月至2013年1月采用钻孔经骨道不可吸收缝线缝合法和锚钉缝合法治疗58例踝关节骨折伴三角韧带完全断裂患者。采用钻孔经骨道不可吸收缝线缝合法治疗29例(A组),男18例,女11例;平均年龄(39.76±11.81)岁;损伤按Lauge-Hansen分类,旋后外旋型Ⅳ度损伤12例,旋前外旋型Ⅲ度损伤5例、Ⅳ度损伤10例,旋前外展型Ⅲ度损伤2例。采用锚钉缝合法治疗29例(B组),男14例,女15例;平均年龄(41.79±13.28)岁;损伤按照Lauge-Hansen分类,旋后外旋型Ⅳ度损伤9例,旋前外旋型Ⅲ度损伤6例、Ⅳ度损伤13例,旋前外展型Ⅲ度损伤1例。对所有骨折行切开复位内固定同时三角韧带行切开探查并手术修复以恢复踝关节内侧结构的稳定性。术后通过临床检查、影像学评估、美国足踝外科学会(AOFAS)踝-后足评分和视觉模拟评分(VAS)对临床结果进行评估,两组结果进行统计分析。结果:全部患者获随访,时间23~40个月,平均27.3个月,踝部骨折均愈合,骨折愈合时间10~17周,平均12.3周,未发生伤口并发症,无踝关节不稳定表现。两组术后AOFAS踝-后足评分(P=0.666)和视觉模拟评分(P=0.905)差异均无统计学意义。结论:钻孔经骨道不可吸收缝线缝合法治疗三角韧带完全断裂能够获得使用锚钉缝合同样优良的临床效果,避免了锚钉术后无法取出的弊端,具有减轻患者经济负担、节约社会医疗资源的优势。     

微创锚钉治疗陈旧踝关节外侧副韧带损伤

目的探讨微创锚钉治疗陈旧踝关节外侧副韧带损伤的临床效果。方法采用微创锚钉治疗30例陈旧踝关节外侧副韧带损伤患者。术后给予支具固定踝关节并进行相关功能锻炼。观察伤口愈合情况,采用AOFAS评分、距骨倾斜角度及距骨移动距离评价疗效。结果伤口均一期愈合。患者均获得随访,时间6~12个月。术后6个月踝关节功能恢复良好,AOFAS评分、距骨倾斜角度及距骨移动距离与术前比较差异均有统计学意义(P<0.001)。结论微创锚钉治疗陈旧踝关节外侧副韧带损伤具有创伤小、高效恢复踝关节稳定及正常功能的效果。     

应用缝合锚钉治疗踝关节三角韧带损伤

目的 探讨应用缝合锚钉治疗踝关节三角韧带损伤的临床疗效.方法 回顾手术治疗踝关节三角韧带损伤21例,均在三角韧带距骨止点处拧入缝合锚钉,同时修复和重建三角韧带深层,浅层直接缝合.结果 随访6～24个月.术后踝关节内侧间隙较术前明显改善,差异有统计学意义(P＜0.05);疗效采用改良Baird-Jackson踝关节评分系统评定,优良率为85.7％.结论 踝关节三角韧带损伤,采用缝合锚钉修补三角韧带,既修复了韧带的连续性,又重建了三角韧带,此方法 具有创伤小、操作简单、固定可靠的特点.     

可吸收锚钉修复三角韧带损伤在踝关节骨折术中的应用

目的观察踝关节骨折术中采用可吸收锚钉修复三角韧带损伤的临床疗效。方法回顾性分析自2017-05—2019-01采用钢板螺钉内固定治疗的36例合并内侧三角韧带损伤的踝关节骨折,术中采用可吸收锚钉修复三角韧带损伤。结果 36例均获得随访,随访时间平均16.4(5.1～26.2)个月。所有患者均未出现组织感染、排斥反应、关节再脱位、骨折不愈合等并发症。骨折愈合时间9.1～17.3周,平均12.5周。末次随访时AOFAS评分:优25例,良9例,可2例,优良率94.4%。1例踝关节活动范围减小,行走后疼痛,无静息痛,口服药物缓解。结论对于合并内侧三角韧带损伤的踝关节骨折,踝关节骨折复位固定后采用可吸收锚钉重建内侧三角韧带可获得更好的踝关节稳定性,减少并发症发生。     

距骨侧锚钉联合内踝部金属垫片修复踝关节骨折合并的三角韧带深层断裂

目的探讨采用距骨侧锚钉联合内踝部金属垫片修复踝关节骨折合并的三角韧带深层断裂的效果。方法回顾性分析自2012-06—2015-08诊治的27例踝关节骨折合并三角韧带深层断裂。三角韧带断裂部位:距骨止点处断裂18例,体部断裂5例,内踝止点处断裂4例。对三角韧带深层断裂者用锚钉在距骨侧置钉,进行重建或修补,并于内踝内侧放置垫片以防止切割及松脱。末次随访时采用踝关节功能AOFAS评分评估疗效。结果 25例术后获得随访,随访时间平均14.2(8~23)个月。未出现神经血管损伤及感染,切口及骨折愈合良好。末次随访时踝关节功能AOFAS评分平均92.4(88~96)分,未出现踝关节内侧不稳定。结论采用距骨侧锚钉联合内踝部金属垫片修复踝关节骨折合并的三角韧带深层断裂的效果满意,操作相对简单,值得临床推广应用。     

缝合锚钉治疗Ⅲ度踝关节外侧副韧带断裂

目的探讨足-踝关节骨折合并外侧副韧带断裂的手术中用锚钉修复外侧副韧带的方法和治疗效果。方法 2006年5月至2007年10月利用缝合锚钉治疗11例合并外侧副韧带损伤的足-踝关节损伤。踝部按Danis-Weber分型,其中1例A型,4例B型,2例C型,足部距骨骨折2例,跟骨骨折2例,据韧带损伤分型均为Ⅲ度韧带损伤。结果术后患者伤口均Ⅰ期愈合。X线片示11例骨折均达骨性愈合,愈合时间11～16周,平均14.8周。按照AOFAS踝与后足功能评分系统评价术后患足功能,本组优（90～100分）3例,良（75～89分）8例。按照Good踝关节外侧副韧带损伤评价标准评价患足外侧韧带功能,达到Ⅰ级者2人,Ⅱ级者8人,Ⅲ级者1人。结论用缝合锚钉修复足-踝关节骨折伴外侧副韧带Ⅲ度韧带损伤是一种简单高效而并发症较少的手术方式。     

锚钉缝合结合中西医康复治疗伴三角韧带断裂的踝关节骨折脱位

目的：探讨锚钉缝合结合中西医康复治疗伴三角韧带断裂的踝关节骨折脱位的疗效。方法：对31例伴三角韧带断裂伴和不伴骨折的踝关节脱位采用锚钉缝合螺钉内固定结合中西医康复治疗;术后随访12～36个月,观察临床效果。结果：踝关节脱位锚钉缝合内固定后复位好,踝关节X线显示内侧间隙术前为（4.91±1.24）、术后为（1.52±.48）比较差异有统计学意义（P＜0.5）;均达骨性愈合,无再脱位,愈合时间12～16周,平均14周;按Baird-Jackson踝关节功能评分系统评定,优28例,良3例。结论：伴三角韧带断裂伴和不伴骨折的踝关节脱位,采用锚钉缝合结合中西医康复治疗是较好的方法。     

Ankle Valgus after Hindfoot Arthrodesis: A Radiographic and Chart Comparison of the Medial Double and Triple Arthrodeses

The medial double arthrodesis, comprised of subtalar and talonavicular joint fusions, has become a popular way to correct hindfoot deformity. There is potential concern for an increase in ankle valgus postoperatively owing to extended medial dissection and possible disruption of the deltoid ligament. Although this approach is often used to correct a valgus hindfoot, little attention has been paid to date on this procedure’s effect on the tibiotalar joint. Although the medial double arthrodesis has been shown to produce reproducible outcomes without violating the lateral hindfoot structures, our hypothesis was that this approach would increase the ankle valgus deformity compared with its triple counterpart. The primary goal of the present retrospective study was to identify the frequency and severity of ankle valgus after the medial double arthrodesis compared with the triple arthrodesis. A total of 77 patients (78 feet) met our inclusion criteria. Their mean age was 61.3 ± 10.7 (range 27 to 79) years, and the follow-up period was 15.7 ± 9.9 (range 6 to 46) months. There were 16 and 61 patients (62 feet) in the medial double and triple arthrodesis groups, respectively. Overall, the preoperative ankle valgus was 1.24° ± 2.02° (range 0° to 6°), and there was no statistical difference of preoperative ankle valgus noted between groups (p = .060). Collectively, postoperative ankle valgus was 3.01° ± 3.54° (0° to 17°) with an increase in ankle valgus in 4 of 16 medial double and 34 of 62 triple arthrodesis patients. With a mean follow-up of 8.75 ± 4.02 (6 to 21) months, the medial double arthrodesis cohort's ankle valgus increased from 0.5° ± 1.55° (0° to 6°) to 1.5° ± 3.14° (1° to 10°) postoperatively. The triple arthrodesis group had a mean follow-up 17.53 ± 10.17 (6 to 46) months and ankle valgus increased from 1.44° ± 2.09° (0 to 6°) to 3.40° ± 3.56° (0° to 17°). Postoperative ankle valgus was statistically significant between groups (U = 303.50, p = .013). The odds of having an increase in the valgus ankle angle for patients in the triple group was 3.64 times that for patients in the double group, while holding all other variables in the model constant.     

Clinical Study of Ankle Fracture Combined With Deltoid Ligament Injury: Repair or Not? A Retrospective,Comparative Study

This study retrospectively evaluated patients with ankle fracture to compare the prognosis between patients who had primary repair of the superficial deltoid ligament and those who did not. A total of 71 patients with ankle fracture and fracture-dislocation combined with deltoid ligament injury were divided into 2 groups: repair of superficial layer group (33 cases) and nonrepair group (38 cases). For the repair group, patients first underwent open reduction and internal fixation of the lateral malleolus and received a stress test. If the syndesmosis was widened, it would undergo fixation of the syndesmosis with screws. If instability of the ankle joint was observed, patients might further undergo repair of the superficial deltoid ligament. Ultimately, postoperative functions were evaluated using the Philips and Schwartz scale. All patients achieved bony union without significant pain. In the repair group, plantar and dorsi flexions were 2.5 ± 4.2° (range 0 to 10) and 7 ± 7.1° (range 0 to 20) less than the normal side, respectively. In the nonrepair group, the plantar and dorsi flexions were 2.8 ± 4.6° (range 0 to 10) and 6.6 ± 5.9° (range 0 to 20) less than the normal side. Meanwhile, the Philips and Schwartz scores of the repair and nonrepair groups were 92.5 ± 4.4 (range 80 to 100) and 93.4 ± 3.8 (range 85 to 100), respectively. But the difference of prognosis between the 2 groups was not statistically significant. In conclusion, for ankle joint fracture combined with deltoid ligament injury, routinely exploring or repairing the deltoid ligament was not recommended, but repair of the deltoid ligament increased stability of the ankle joint in the early postoperative stage.     

自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定

目的:探讨自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定的临床疗效.方法:回顾性分析2016年7月至2019年7月采用自体腓骨短肌腱解剖重建距腓前韧带和跟腓韧带治疗的42例慢性踝关节外侧不稳定患者,其中男30例,女12例;年龄25～46(37.6±12.4)岁;左足15例,右足27例;受伤至手术时间3～...     

Deltoid ligament reconstruction with autologous gracilis tendon in chronic medial ankle instability after ankle fracture surgery: A case report

IntroductionThe repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented.Case reportA 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle.DiscussionThe deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability.ConclusionIn the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option.     

Early radiographic outcomes following deltoid ligament repair in bimalleolar equivalent ankle fractures

BackgroundIndications for deltoid ligament repair in bimalleolar equivalent ankle fractures are unclear. This study compared radiographic outcomes in bimalleolar equivalent ankle fractures undergoing open reduction internal fixation (ORIF) +/? deltoid ligament repair.MethodsA retrospective review of 1024 ankle fractures was performed. Bimalleolar equivalent injuries treated with ORIF +/? deltoid ligament repair were included. Radiographic assessment was performed preoperatively, and at three months postoperatively.ResultsOne hundred and forty-seven ankle fractures met inclusion criteria with 46 undergoing deltoid ligament repairs. There was a significant decrease in medial clear space (1.93 ± 0.65 mm vs. 2.26 ± 0.64 mm, p = 0.01), and tibiofibular clear space (3.89 ± 1.20 mm vs. 4.87 ± 1.37 mm, p = 0.0001) at 3 months postoperative in the deltoid repair group compared to the no repair group. When syndesmotic fixation was performed, there were no differences between groups.ConclusionDeltoid ligament repair in bimalleolar equivalent ankle fractures resulted in reduced medial clear space, and tibiofibular clear space in the early postoperative period. These differences were small and remained within established normal limits.Level of clinical evidenceLevel III, retrospective cohort study.     

创伤后踝关节慢性疼痛的关节镜诊治

目的：探讨对创伤后慢性踝关节疼痛患者行关节镜检查的诊断和治疗价值。方法：自1999年4月至2008年6月,收治39例创伤后踝关节慢性疼痛的患者,男15例,女24例;年龄15～58岁,平均32岁。病程2个月～11年,平均18个月,其中X线显示受伤时骨折脱位者26例。均行关节镜检查,明确关节内病变状况,并对相应病变行镜下清理术,采用美国足踝外科学会（AOFAS）后足踝评分表对手术前后功能状况进行评分。结果：软骨损伤及退变26例,游离体形成3例,撞击综合征21例。引起主要撞击的组织有：滑膜增生3例;韧带断裂后断端撞击10例,包括距腓前韧带断裂7例,下胫腓韧带前内侧束远端断裂3例;半月板样组织撞击6例;骨软骨增生撞击3例。平均随访（14.2±8.4）个月（5～36个月）,术后关节功能AOFAS评分由术前的平均（59.7±16.9）分改善为（68.8±21.2）分,其中主观评分改善更为明显,术前平均（22.8±10.0）分,术后（29.5±12.1）分。结论：对于踝关节损伤后慢性疼痛患者,尤其是X线无骨折脱位者,及时行关节镜检查,有助于明确关节内具体病变状况,且术中一并进行关节清理,能显著改善关节功能。     

自体与异体肌腱微创重建踝关节外侧韧带的临床对比研究

 目的 比较应用自体半腱肌腱与同种异体肌腱微创移植重建踝关节外侧韧带的临床疗效。方法 回顾性分析2006年9月至2011年6月采用微创手术治疗慢性踝关节外侧不稳患者资料。其中应用自体半腱肌腱重建踝关节外侧韧带（自体组）32例,男19例,女13例;年龄17～62岁,平均32.4岁。同期应用同种异体肌腱重建踝关节外侧韧带（异体组）36例,男22例,女14例;年龄15～67岁,平均34.2岁。两组患者均采用相同的手术方法重建距腓前韧带及跟腓韧带。结果 自体组手术时间[（85.5±11.5） min］长于异体组[（58.1±10.2）min］,发热天数异体组[（5.5±1.5）d］长于自体组[（2.5±1.2）d］。自体组23例随访（33.5±6.7）个月,异体组26例随访（28.5±6.7）个月。美国足踝外科协会（AOFAS）踝与后足评分,自体组术前（62.3±8.2）分,术后（95.1±7.5）分;异体组术前（60.2±8.4）分,术后（94.8±5.5）分。5例患者（自体组3例、异体组2例）在不平地面行走时,踝关节有残余不稳定。自体组1例患者平整地面行走踝关节有残余不稳定。自体组无一例膝部肌腱供区功能障碍。术后AOFAS评分自体组16例为优,5例为良,2例为差;异体组17例为优,5例为良,4例为差。应力位X线片示自体组距骨倾斜角平均由14.0°减少到3.8°,异体组平均由13.0°减少到3.6°;距骨前移距离自体组平均由12.3 mm减少到4.6 mm,异体组平均由11.5 mm减少到4.3 mm。结论 自体肌腱与同种异体肌腱移植重建踝关节外侧韧带的临床疗效无差异,但自体肌腱愈合时间较异体肌腱快,而异体肌腱具有损伤小,手术简便等优点。     

Surgical Outcomes of Articular Surface Crush Injury of Hawkins Ⅲ Talus Neck and Medial Malleolus Fracture

The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ± 5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ± 7.08; activities of daily living score 89.57 ± 8.88; quality-of-life score 89.20 ± 7.44; sports score 75.00 ± 15.49; and other symptoms score 84.74 ± 7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ± 6.39. The VAS score was 0.72 ± 0.65. Ankle motion included dorsiflexion (13.18° ± 9.02°) and plantar flexion (32.27° ± 12.34°). Subtalar joint motion included eversion (10.91° ± 7.01°) and inversion (11.36° ± 7.45°). All scores of the healthy side were higher than those of the affected side (p < .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores > 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.     

撬拨复位内固定治疗儿童内踝骨折伴骨骺损伤的疗效评价

目的 探讨克氏针撬拨闭合复位空心螺钉内固定治疗儿童内踝骨折伴骨骺损伤的临床疗效。方法 回顾性分析2014年6月至2019年6月我院采用克氏针撬拨闭合复位空心螺钉内固定治疗的35例内踝骨折伴骨骺损伤的患儿病例资料。男25例,女10例,年龄5-15岁,平均(8.3±2.8)岁。左踝16例,右踝19例。按Salter-Harris骨骺损伤分型：Ⅲ型22例(包括2例Tillaux骨折),Ⅳ型 13例。手术在C型臂X线机透视下进行,取细克氏针采用撬拨闭合复位空心螺钉内固定,记录双侧小腿的长度、手术时长、手术过程中的出血量、随访的时间以及手术前和手术后的踝关节AOFAS踝-后足功能评分、ASAMI评分、围手术期并发症发生情况等。结果 所有患儿均顺利完成手术,手术时间30-55min,平均(40.2±3.8)min,术中出血5-20ml,平均(12.1±2.7)ml。所有患儿均获得随访,随访18～48个月,平均(32.2±4.9)个月。健侧小腿的与患侧小腿长度差异无统计学意义(P>0.05)。随访的35例患儿AOFAS踝-后足功能评分较术前有显著的统计学差异(P<0.05),患侧足踝ASAMI评分显示：优34例,良1例,优良率100%。X线及CT检查提示所有病例在末次随访时均骨性愈合。并发症方面所有患儿均未出现术中及术后并发症,末次随访时所有患儿踝关节活动均不受限,均能参加日常活动及功能锻炼。 结论 克氏针撬拨闭合复位空心螺钉内固定术治疗儿童内踝骨折伴骨骺损伤的疗效确切,手术时间短、手术过程中出血量少、对内踝骨折块固定牢靠,值得在临床工作中进一步推广应用。