【摘要】 目的总结旋后内收型Ⅱ度踝关节骨折的手术治疗经验。方法从2008-09/2012-10月,作者医院对20例旋后内收型Ⅱ度踝关节骨折行手术治疗,其中男13例,女7例,年龄19~60岁,平均36.8岁,均为闭合型骨折,均采取手术治疗。内踝骨折采取前内侧入路,同时探查胫骨远端内侧关节面及距骨软骨面。对于不伴胫骨远端内侧关节面塌陷的予直接复位固定内踝,存在胫骨远端内侧关节面塌陷的予以复位植骨固定后再行内踝复位固定。对于存在距骨软骨面剥脱的,予以去除剥脱的软骨,暴露的骨面予微骨折处理。外侧结构损伤Ⅰ期修复。本组采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分评估患踝术后功能。结果 20例中16例获随访,时间12~24个月,平均17个月。术后所有切口均Ⅰ期愈合,无感染,无神经损伤表现,随访期间内无影像学创伤性关节炎征象。术后末次随访AOFAS踝-后足评分为71~93(80.9±5.4)分,其中优6例,良11例,可3例,优良率85%。结论对于旋后内收型Ⅱ度踝关节骨折,处理踝关节内外侧结构损伤的同时还需要注意胫距内侧关节面的情况,并予以处理,可提高手术疗效。更多还原

【Abstract】 Objective To introduce our experience of surgical treatment for supination-adduction stage Ⅱ ankle fractures.Methods From September 2008 to October 2012,20 patients who sustained unilateral supination-adduction stageⅡ ankle fractures were received surgical treatment in the author’s hospital.There were 13 males and 7 females with an average age of 36.8 years(19-60 years).All the fractures were closed fractures,and underwent surgical treatments.Anteromedial incision was used to expose articular surface of the medial tibial plafond and talar dome.Reduction and fixation of the medial malleolus was performed directly in cases without impaction of the tibial plafond,otherwise bone grafting should be performed firstly.Cartilage debris was removed and the exposed bone surface was treated with microfracture in cases with cartilage denudation of the talar dome.The injured lateral structure was always repaired primarily.Functional outcomes were assessed with the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot clinical rating system postoperatively.Results Of 20 patients,16 were followed up postoperatively for a mean period of 17months(12-24 months).All the incisions got primary healing.Neither infection nor neural lesion was observed.No posttraumatic arthritis was detected in the X-ray examination during the follow-up.The AOFAS score of the last follow-up was80.9±5.4(71-93).There were 6,11 and 3 excellent,good and fair results respectively.The excellent-good rate was 85%.Conclusion Articular surface of the medial tibial plafond and talar dome should be explored and well managed when performing an operation for a supination-adduction stageⅡ ankle fracture in order to achieve an favorable outcome.更多还原