踝关节骨折合并Tillaux-Chaput和Volkmann骨折的临床特点及治疗方法

 目的 探讨踝关节骨折合并Tillaux-Chaput和Volkmann骨折的临床特点及治疗方法。方法 2005年9月至2012年1月采用手术治疗并获得随访的踝关节骨折合并Tillaux-Chaput和Volkmann骨折患者15例，男8例，女7例；年龄16~57岁，平均27.3岁；均为内踝、腓骨骨折合并Tillaux-Chaput和Volkmann骨折。8例Tillaux-Chaput骨折经X线片确诊，7例经CT扫描确诊。依据踝关节骨折Lauge-Hansen分型，旋前外展型Ⅲ度11例，旋前外旋型Ⅳ度4例。采用后外侧入路，复位腓骨骨折后以钢板固定，复位Volkmann骨折后以1~2枚空心螺钉固定；采用内侧弧形切口显露内踝骨折，复位后以空心螺钉固定；于胫骨前结节做纵行切口，复位Tillaux-Chaput骨折后以空心螺钉固定。根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝与后足评分标准评价踝关节功能。结果 随访8~20个月，平均12.5个月。骨折均愈合，愈合时间12~36周，平均23.5周。末次随访时12例行走正常，3例轻度跛行。AOFAS评分71~94分，平均85.4分；其中优9例、良4例、可2例，优良率86.7％(13/15)。3例踝关节活动受限，3例下地负重行走时疼痛不适。结论 Tillaux-Chaput及Volkman骨折多发生于旋前外展型踝关节骨折时，X线检查容易漏诊，CT检查可明确诊断，手术治疗要求精确复位及固定。

Characteristic and treatment of ankle fracture combined with Tillaux-Chaput and Volkmann fractures

Objective To explore the clinical characteristics and operative methods of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures. Methods The data of 15 patients who were suffered the ankle fracture combined with the simultaneous fractures of Tillaux-Chaput and Volkmann between September 2005 and January 2012 were analyzed. There were 8 males and 7 females with an average age of 27.3 years (range, 16-57 years). All had medial malleolar and fibular fracture with Tillaux-Chaput and Volkmann tubercle avulsed fracture. X-ray film shows that there were 8 cases in which the patients had Tillaux-Chaput fracture, among whom 7 were diagnosed by CT scan. Classified by Lauge-Hansen system, ankle fracture could be divided into pronation-external rotation type in 4 cases, and pronation-abduction type in 11 cases. The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach. The fibular fracture was fixed with plate. The medial malleolar fracture was explored from medial curve approach. Tillaux-Chaput fracture was treated by the microtubule cut. All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS). Results All patients were followed up for 8-20 months (average, 12.5 months). The fracture healed 12-36 weeks later in all the 15 patients, with an average of 23.5 weeks. Twelve patients walked normally and 3 with mild claudication in the last follow-up. The AOFAS score was average 85.4 points, 9 were excellent, 4 were good, 2 were fair, with the good-excellent rate being 86.7%(13/15). The movement of ankle joint limited in 3 patients, tenderness occurred when weight bearing in 3 patients. Conclusion The ankle fracture include the simultaneous fractures of Tillaux-Chaput and Volkmann were more seen in the type of pronation-abduction. It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments. The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures. Inferior tibia fibular screw was not routinely used in this fracture.