踝关节骨折脱位326例手术治疗

目的:评价踝关节骨折脱位手术治疗的效果,总结治疗经验。方法:回顾分析踝关节骨折脱位326例,共随访225例,失访101例,随访4～120个月,平均38.4个月。按照美国足踝外科协会后足评分系统诸项内容及相关客观检查进行评分。结果:225例患者中优111例,良84例,一般21例,差9例,手术治疗的优良率为86.7%。出现1例浅层感染,2例深层感染,1例骨折不愈合,5例骨折畸形愈合,6例创伤性关节炎,有3例出现皮肤坏死,5例克氏针滑移;应用生物可吸收性螺钉4例出现明显皮肤刺激,其中1例需二次手术将螺钉帽截断。有68例患者术后长时间伤口部位疼痛或酸胀感,尤其是阴雨或寒冷时,占随访患者的30.2%。结论:踝关节骨折脱位手术治疗能获得较好的治疗效果,开放性骨折、合并脱位、复位质量是影响预后的主要因素。解剖复位和恢复关节面平整是踝关节骨折脱位手术治疗的关键。

Surgical treatment for fracture and dislocation of ankle joint in 326 cases

Objective To evaluate the effect of surgical treatment for fracture and dislocation of ankle joint and sum up the experience. Methods 326 patients with fracture and dislocation of ankle joint from January 1996 to January 2006,of who 225 cases were followed up from 4 to 120 months (average 38.4 months) were evaluated by the ankle-hindfoot score of American Orthopedic Foot and Ankle Society Score (AOFAS). Results Of 225 patients,there were 111 cases with excellent result,84 cases with good result,21 cases with general and 9 cases with poor result,the excellent and good rate was 86.7 %. There were 1 case with shallow infection,2 cases with deep infection,1 case with nonunion,5 cases with malunion,6 cases with traumatic arthritis,3 cases with skin necrosis,and 5 cases with kutcher nail sliding from the bone cavity. There were 4 cases with skin irritation in patients with the use of absorbable screw,of who there was 1 case needed to be cut the cap of the screws by the second operation. There were 68 cases (30.2%) with a feeling of pain in the regional incision,especially in a rainy or a cold day. Conclusions There was satisfactory effect of the surgical treatment for fracture and dislocation of ankle joint. Open fracture and dislocation,and the quality of reduction were the main factors which influence the prognosis of patients. Anatomy reduction and articular surface recover to smooth were the key points of surgical treatment for fracture and dislocation of ankle joint.