Dupuytren骨折的诊断和治疗

目的:探讨Dupuytren骨折的诊断和治疗。方法:20例患者中男14例,女6例;平均年龄32·8岁(19~65岁)。左踝12例,右踝8例。扭伤14例,坠落伤3例,车祸伤3例。开放伤5例,闭合伤15例。明确诊断时间:2h内13例,3d内5例,7d内2例。13例通过踝关节正侧位X线片确诊,5例在加摄小腿全长正侧位X线片后确诊,2例在行双踝外翻应力X线片对照检查后确诊。20例确诊患者均行腓骨解剖复位半管形钢板内固定,10例伴内踝骨折者在内踝复位后用松质骨螺钉或张力带固定,14例固定下胫腓联合。结果:通过对17例患者进行了1·3~6年(平均3·1年)的随访,根据Meyer和Kumler的踝关节功能评价标准,17例中优10例,良4例,一般2例,差1例(此例患者在2个月后踝关节正侧位X线片显示内踝踝穴增宽)。结论:对于Dupuytren骨折,早期准确的诊断和正确的外科治疗是恢复踝关节良好功能的关键。

Diagnosis and treatment of Dupuytren fracture

Objective:To study the diagnosis and treatment of Dupuytren fracture.Methods:There were 20 patients(14 male,6 female)with an average age of 32.8 years (range from 19-65 years).Left ankle 12 cases and right ankle 8 cases;strain in 14 cases,falling injury in 3,traffic accident in 3;open injury in 5 and close injury in 15.The time from injury to diagnosis:13 cases in 2 hours,5 in 3 days,2 in 7 days.13 cases were diagnosed by anterior and lateral X-ray,5 cases were diagnosed by full tibiofibular anterior and lateral X-ray, 2 cases were diagnosed by contrast the bimalleolar stressing X-ray.All patients were treated with fibula open reducted anatomically and fixed by 1/3 tubular plate.10 cases with internal malleolar fracture were fixed by lag screw or tension band after reduction,the syndesmosis in 14 cases were fixed.Results:17 cases were followed-up from 1.3 to 6 years with an average of 3.1 years.The clinical effect were evaluated according to the criteria of Meyer and Kumler,the excellent in 10 cases,good in 4,fair in 2,poor in 1(after 2 months,the patient's ankle cave were lenient in anterior and lateral X-ray).Conclusion:Earlier,accurate diagnosis and surgical treatment for Dupuytren fracture is the key to recovery function of ankle joint.