累及关节的下肢骨折临床治疗与疗效分析

【摘要】〓目的〓总结下肢关节内骨折的临床治疗和康复方法。方法〓手术治疗下肢关节内骨折55例,根据骨折类型并结合主骨折块与塌陷部位选择切口显露,骨折压缩部位复位后的骨缺损应用髂骨或人工骨植骨,术中通过C臂X线机透视及下肢力线测量辅助骨折复位评估,根据不同部位骨折选用相应内固定固定。术后根据韧带损伤修复情况决定关节屈伸锻炼进度,并循随访骨折愈合情况而逐步负重。 结果〓49例获得随访,随访时间3~18个月,平均6个月。骨折均在16周内愈合,累及膝关节骨折者,采用Rasmussen评分标准评定临床疗效,结果为优26例,良2例,可1例,差2例,优良率90.3%。累及踝关节骨折者,采用评分Mazur踝关节评价分级系统评估,结果为优13例,良3例,可1例,差1例,优良率88.9%。结论〓累及关节的下肢骨折手术治疗,骨折压缩部位复位后植骨支撑骨缺损,恢复关节面平整及正确的下肢力线,注意修复关节韧带,有效内固定而满足早期功能锻炼,术后适时早期功能锻炼,可获得良好的治疗效果。

Clinical effect analysis on fracture of lower limb involved joint

Objective To summarize the clinical treatment and rehabilitation procedure of intra- articular fractures of the lower limbs. Methods Fifty-five cases with intra-articular fractures of the lower limb were included. The incision was chosen according to the type of fracture and main site of the fracture fragments and collapse. Bone graft from iliac and allogeneic bone were applied to fill the bone defect site caused by compression fractures. C-ann and intra-operative measurement of lower-extremity- alignment were applied to evaluated the reduction of fracture. Effective internal fixation was according to the type of fracture. Joint exercise schedule was decided according to repair of ligament injury, stepwise loading exercise was applied and according to fracture healing. Results Forty-nine cases were followed up for 3 to 18 months, an average of six months. Fractures were healed at 16 weeks, involving the knee fracture. Rasmussen scoring criteria used to evaluate the efficacy of intra-articular fracture of knee showed excellent in 26 cases, good in 2 cases, and the excellent and good efficacy reached 90.3%. Mazur scoring criteria used to evaluate the efficacy of intra-articular fracture of ankle showed excellent in 13 cases, good in 3 cases, the excellent and good rate reached 88.9%. Conclusion Bone allograft to fill bone defect site, restoring the articular surface, and reduction of limb alignment were necessary during the operation of the lower extremity intra-articular fractures. Ligament repairing, effective internal fixation and early functional exercise leads to a good therapeutic effect.