关节镜辅助下空心钉内固定治疗伴后踝骨折的踝关节骨折

目的探讨关节镜辅助下空心钉内固定治疗后踝骨折的临床疗效。方法对2009年1月~2012年12月收治的16例伴有后踝骨折的踝关节骨折病例资料进行回顾性研究,其中男性11例,女性5例;年龄19~65岁,平均26岁。损伤按照Lauge-Hansen分类:旋后外旋型Ⅲ度损伤3例,旋后外旋型Ⅳ度损伤10例,旋前外旋型Ⅳ度损伤3例。骨折按照AO/OTA分型:43-B2型4例,43-B3型10例,43-C3型2例。所有患者先于仰卧位对外踝和(或)内踝进行固定,然后同时使用踝关节镜进行前踝关节镜检查,根据探查情况同时行游离碎骨块取出、韧带清理、微骨折等治疗。再行俯卧位手术,于踝关节镜下行后踝复位、空心钉固定及其它处理。术后通过临床检查、影像学评估、美国足踝外科学会(AOFAS)的踝-后足评分和视觉模拟评分(VAS)对临床结果进行评估。结果 16例术后获12~32个月(平均19个月)随访,骨折愈合时间为10~16周(平均12.8周)。末次随访时AOFAS踝-后足评分为83~100分(平均93.4分),VAS评分为0~3分(平均1.2分),无踝关节创伤性关节炎的表现。结论使用关节镜辅助空心钉内固定治疗合并后踝骨折的踝关节骨折临床疗效良好,且具有创伤小、疗效好、并发症少等优点。

Arthroscopy-assisted reduction and internal fixation by hollow screw for treatment of the ankle with posterior malleolus fracture

Objective To evaluate the effectiveness of the arthroscopy-assisted reduction and internal fixa-tion by hollow screw for treatment of the ankle with posterior malleolus fracture .Methods The clinical data of 16 patients11 males and 5 females ranged from 19-65 (average,26) years] with posterior malleolus fracture from Jan. 2009 to Dec.2012 was retrospectively analyzed .According to Lauge-Hansen classification ,there were 3 supinationev-ersion stageⅢfractures,10 supination-eversion stage Ⅳfractures,and 3 pronation-eversion stage Ⅳfractures.Ac-cording to AO/OTA classification,there were 4 case of 43-B2,10 cases of 43-B3,and 2 cases of 43-C3.All the pa-tients were treated with arthroscopy-assisted reduction and internal fixation by hollow screw .The clinical effects were evaluated according to AOFAS scores and VAS scores .Results All the patients were followed up from 12 to 32 months(average 19 months).The bone healing was obtained from 10 to 16 weeks (average 12.8 weeks).At the final review,the AOFAS score was from 83 to 100(average 93.4),the VAS score was from 0 to 3(average1.2).No trau-matic arthritis was observed . Conclusion Arthroscopy-assisted reduction and internal fixation by hollow screw for the treatment of acute ankle fractures is not only helpful for anatomical reduction of the articular surface ,but also can improve the clinical results with effective diagnosis and treatment of combined intra-articular disorders .