踝部骨折治疗效果与距骨生物力学的关系

背景距小腿(踝)关节的解剖结构并不复杂,但其生物力学关系十分重要.距骨参与组成3个关节,对距小腿关节功能起极其重要作用.因此恢复踝穴的解剖关系,稳定距骨在其中的位置甚为重要.目的探讨踝部骨折的治疗与距骨生物力学的关系.设计非随机非对照的研究.地点和对象1985-01/2000-10中国医科大学附属第一医院收治距小腿关节骨折患者95例.收集患者因恶性肿瘤截肢后小腿标本3只.干预通过离体小腿标本,对距骨在踝部骨折中生物力学关系做简要观察,并对95例距小腿关节骨折治疗后的临床及X射线加以分析.主要观察指标①观察不同骨折类型受力情况.②观察距小腿关节恢复的临床疗效与距骨生物力学变化的关系.结果随访65例,优41例,良12例,尚可7例,差5例.生物力学结果双踝骨折时,头颈压缩0.48 cm;外踝骨折,垂直压力时外踝面受力大于内踝面,腓骨下1/3骨折,内翻位时距骨外踝面受力轻于内踝面.结论距小腿关节骨折不论手法复位外固定或手术复位内固定,均应注意距骨在踝穴内解剖关系,并注意下胫腓关节间隙距离.恢复踝穴和距骨的生物力学关系是极为重要的治疗标准.

Treatment of ankle fracture and biomechanics of talus

BACKGROUND: The anatomical structure of ankle joint is not complicated, but its biomechanics is very important. The talus has participated in consisting of three joints and played very important role in supporting the functions of ankle. Therefore, it is very important to stabilize the position of talus in order to restore the anatomical structure of ankle.OBJECTIVE: To explore the relationship between treatment of ankle fracture and the biomechanics of the talus.DESIGN: A non-randomized case controlled study was conducted.SETTING and PARTICIPANTS: There were 95 patients with fracture of ankle joints during January 1985 to October 2000 from the First Affiliated Hospital of China Medical University. Three specimens of amputating legs due to malignant tumor were collected.INTERVENTIONS: The biomechanics of talus in ankle fracture was observed by amputated leg specimens and the clinical manifestation and Xray examinations were analyzed in the 95 fracture patients after treatment.MAIN OUTCOME MEASURES: Forces acting on different fracture types,relationship between therapeutic effects and biomechanics of talus.RESULTS: Sixty-five cases were followed up. There were 41 cases with very good therapeutic effects, 12 cases with good effects, 7 cases with fair effects and 5 cases with poor effects. Biomechanics results: the neck was compressed 0.48 cm when both ankles were broken. The lateral malleolar facet got more pressure than medial malleolar facet when vertical pressure acted in external facet fracture. When fracture happened in the lower 1/3 of fibula, the pressure acted on lateral malleolar facet was less than that on medial malleolar facet when in inversion position.CONCLUSION: It should pay more attention to the anatomical relations of talus in ankle cavity and the gap of lower tibiofibular joint no matter external fixation or internal fixation of manual reposition to ankle fracture was used. It is a very important treatment standard to restore the biomechanical relationship between ankle cavity and talus.