腓骨远端骨折使用腓骨钩锁定钢板治疗24例疗效分析

目的:探讨腓骨远端骨折使用腓骨钩锁定钢板的治疗经验及临床疗效。方法:2006年4月~2010年4月,对24例伴有腓骨远端粉碎性骨折的踝部骨折行切开复位内固定术,所有病例均得到完整随访,男15例,女9例;年龄20~74岁,平均38岁;单纯外踝骨折6例,双踝骨折11例,三踝骨折7例。按Danis-Weber分类,A型11例,B型13例,均为腓骨远端不稳定粉碎性骨折。受伤至接受手术的时间为8小时~18天。手术顺序为外踝、内踝和后踝。外踝骨折使用腓骨钩状锁定钢板固定,内踝骨折使用松质骨螺钉,后踝骨折根据骨折块大小及形态使用螺钉或钢板固定。结果:术后随访10~38个月,平均20.6个月。术后4~6周X线片均可见骨折线模糊;20例患者于术后12周达到临床临床愈合,4例于术后24周达到临床愈合。伤口均1期愈合,无1例发生感染、局部不良反应及踝关节不稳。Mazur评分为69~93分,平均87.2分,其中优14例,良7例,可2例,差1例,优良率为91.3%。结论:腓骨远端骨折使用腓骨钩锁定钢板治疗能更好恢复外踝正常外翻及长度等解剖结构,并有效固定,为早期活动提供稳定性,利于踝关节功能恢复。

The Restoration of the Clinical Outcome of Lateral Malleolar Anatomical Hook-plate for 24 cases Unstable Distal Fibular Fracture

Objective: To evaluate the clinical outcome of lateral malleolar,s anatomical hook-plate in treating ankle fracture including distal fibular fracture.Methods: 24 patients of ankle fracture including distal fibular fracture were treated from Apr 2006 to Apr 2010.There were 15 males and 9 females with an average age of 38 years(range,20-74years).The distal fibular fracture were treated with lateral malleolar′s anatomical hook-plate.The medial malleolus was fixed with cancellous bone screw.The posterior malleolus was fixed with screw or plate according to the pattern of fracture.Results: The mean follow-up period was 20.6 months with a range from 10 to 38 months.No obvious fracture line could be seen on the radiographs 4-6 weeks after operation.Bone healing was achieved in 20 cases 12 weeks after operation and in 4 cases 24 weeks after operation.All surgical incisions healed adequately.There were no instances of infection,instability of ankle and other complications.According to Mazur ankle joint scoring scale system,the final result was scored from 69 to 93(average 87.2).There were excellent in 14 cases,good in 7,fair in 2,and poor in 1case.The excellent and good rate was 91.3%.Conclusion: The lateral malleolar,s anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus,with advantage of restoring anatomic structure,joint activity effectively and firm fixation.