手术治疗三踝骨折的临床研究

目的:探讨三踝骨折手术治疗方法和围手术期处理。方法:对54例采用切开复位内固定治疗的三踝骨折患者的资料进行回顾性分析,其中男38例,女16例,年龄21～76岁。AO分型,B型24例,C型30例。开放伤14例,闭合伤40例。手术距受伤时间4h～14d,骨折复位顺序为后踝-外踝-内踝。后踝选用可吸收螺钉或金属螺钉固定,外踝用1/3管状钢板螺钉固定,内踝用1～2枚拉力螺钉固定。术后行系统性功能锻炼。结果:随访时间10个月～2.5年,平均14个月,骨折均愈合。以改良Bird-Jackson踝关节疗效评定标准评判总优良率89%。结论:适当的手术入路,准确的骨折复位,有效的内外固定,积极的术后康复可使大多数三踝骨折患者恢复踝关节的正常功能。

Surgical treatment for trimalleular fracture

Objective To explore the surgical and periodical treatment for trimalleolar fracture. Methods We retrospectively analyzed the data of 54 patients with trimalleolar fracture who were treated by ORIF. Of these patients,there were 38 males and 16 females,aged from 21 to 76. 14 cases were open fracture and 40 cases were closed fracture. According to Danis-Weber's classification,there were 24 cases were type B and 30 were type C. The duration between injury and operation were 4 hours to 14 days. The fractured malleolus were reducted with the sequence of posterior-lateral-medial. The lag cancellous screw was used for medial malleolar fractures,titanic plate and screw for lateral malleolus and obsorbable screw for posterior malleolus. Postoperative exercise was performed with systemic planning. Results All fractures were union after a followed-up period of 10 to 30 months (14 months average),and the total satisfactory rate was 89% with the Bird-Jackson criterion. Conclusion Proper approach,accurate reduction,stable internal fixation and systemic rehabilitation can help patients with trimalleolar fractures regain the normal function of ankle joint.