旋前外旋型踝关节骨折损伤特点及疗效分析

目的探讨旋前外旋型踝关节骨折的损伤特点及手术治疗疗效。方法回顾性分析2011年1月—2014年2月手术治疗的21例旋前外旋型踝关节骨折患者,男性11例,女性10例;平均年龄33.9岁(16~57岁)。阅读X线片及CT等影像学资料,判断是否合并后踝骨折、下胫腓联合分离、胫距关节脱位及胫距关节面是否粉碎,采取Baird-Jackson踝关节功能评定标准判定手术疗效。结果 21例中旋前外旋型Ⅳ度19例,Ⅲ度2例,其中18例存在下胫腓联合分离,15例使用螺钉稳定下胫腓联合。合并后侧及外侧脱位者14例,外侧脱位者1例,后侧半脱位者1例,无脱位者5例,脱位率76.2%。7例后踝骨折胫骨远端关节面塌陷,可见游离骨碎片。末次随访(术后11~13个月,平均12.4个月)时,Baird-Jackson评分为81~100分,平均94.1分;其中优10例,良6例,中5例,优良率76.2%。结论旋前外旋型Ⅲ~Ⅳ度踝关节骨折多合并胫距关节脱位及下胫腓联合分离,需要复位固定下胫腓联合,正确的解剖复位及内固定,可获得满意的临床疗效。

Injury characteristics and surgical outcomes of pronation external rotation ankle fractures

Objective To explore the injury characteristics and surgical outcomes of pronation external ro-tation ankle fracture. Methods Twenty-one cases with pronation external rotation ankle fracture treated by surgery between Jan. 2011 and Feb. 2014 were retrospectively analyzed. There were 11 males and 10 females,with a mean age of 33. 9 years(range,16-57 years old). According to the preoperative X-ray and CT scan,posterior malleolar fractures,syndesmosis malreduction,dislocation of the tibiotalar joint,and the fragments of the tibiotalar joint were observed. The Baird-Jackson score was used to assess the outcome of the surgery. Results There were 19 cases of Ⅳ degree pronation external rotation ankle fractures and 2 cases of Ⅲdegree pronation external rotation ankle frac-tures. There were 18 cases of syndesmotic malreduction,among whom 15 patients were treated with syndesmotic sta-bilization by screw fixation. There were 14 cases of both posterior and lateral dislocation,1 case of lateral disloca-tion,1 case of posterior semi-dislocation,and 5 cases without dislocation. The rate of dislocation was 76. 2％(16/21). For the 7 cases of posterior malleolar fractures,there were fragments behind the collapse of distal tibial articu-lar surface. According to the Baird-Jackson score,10 cases were excellent,6 were good,5 were fair,and the excellent and good rate was 76. 2％(16/21). Conclusion Pronation external rotation Ⅲ degree and Ⅳ degree ankle frac-tures are often combined with tibiotalar joint dislocation and syndesmotic injury, which requires stabilization by screw. Stable internal fixation and anatomic reduction are good solutions for ankle fracture,which can obtain satis-factory outcomes.