踝关节骨折手法整复与手术治疗比较

目的 探讨对踝关节骨折手法整复和切开复位内固定治疗的优良率差异。方法 对206例踝关节骨折患者采用手法整复、石膏夹外固定和切开复位内固定。伤后到治疗时间平均6．5小时。随访时间1～5年。结果 采用手法整复踝关节骨折共85例，其中，单踝骨折优良率92．1％，双踝骨折优良率87．8％，三踝骨折优良率为50％，合并下胫腓联合分离优良率为50％。手术治疗踝关节骨折121例，其中，单踝骨折优良率95．8％，双踝骨折优良率为96．1％，三踝骨折优良率为93．3％，合并下胫腓联合分离的优良率为87．5％。双踝骨折、三踝骨折及合并下胫腓联合分离的优良率手术组较手法整复组明显增高。结果有显著性差异。同时，在消肿时间方面，手术组较手法整复组明显缩短。结论 外踝关节面以下的骨折是造成距骨脱位的主要原因，解剖复位外踝是治疗的关键。双踝、三踝及合并下胫腓联合分离的骨折应该手术切开复位内固定。

The Comparison of manipulative treatment and operative treatment for the ankle fractures

Objective:To compare the result of manipulative treatment and operative treatment for the ankle fractures. Methods:Two hundred and six cases of ankle fractures were retrospectively studied.Eighty-five cases were treated by manip- ulative reduction and plaster fixation,one hundred and twenty-one cases were treated by open reduction and internal fixa- tion.The average time from injury to treatment was 6.5hours.Results:The finess rate of single ankle fractures treated by manipulative reduction was 92.1%,bimalleolar ones 87.8%,.Trimalleolar ones 50%,and ones with separated tibiofibula 50%.While the finess rate of single ankle fractures treated by open reduction was 95.8%,bimalleolar ones 94.1%,.tri- malleolar ones 93.3%,and ones with separated tibiofibula 87.5%.Conclusion:Anatomy reduction was the key point of treatment for ankle fractures,bimalleolar or trimalleolar ankle fractures accompanied with separated tibiofibula should be treated with open reduction and internal fixation.