CAJ | 학술논문

目的探讨及总结旋后内收型Ⅱ度踝关节骨折的治疗策略及经验.方法 2003年3月-2008年9月,对32例旋后内收型Ⅱ度踝关节骨折进行手术治疗,其中男21例,女11例;年龄21～76岁,平均44.5岁.其中3例为开放性骨折.采取前内侧入路暴露内踝垂直骨折线及胫骨远端内侧关节面,探查胫骨远端关节面及距骨软骨受损情况,对塌陷受损的胫骨远端关节面进行植骨以恢复其高度,内踝直视下解剖复位,清除关节内脱落的软骨碎片;外侧韧带撕裂损伤根据稳定性情况决定是否修复,外踝移位骨折根据骨折块的大小及移位程度选择内固定.X线片观察术后骨折愈合、内固定及是否伴骨性关节炎情况,测量踝关节活动度恢复情况,同时按Maryland后足评分系统对踝关节功能进行评估.结果 32例中23例获随访,时间6-47个月,平均27.9个月.1例术后5个月出现2枚螺钉突出皮下予取出,余X线片显示无内固定松动、断裂,骨折2.3～5.1个月(平均2.9个月)后均愈合,随访时间内未出现骨性关节炎表现,踝关节活动度背伸为6°～17°,平均13°;跖屈27°～46°,平均36°.按Maryland后足评估标准,评定优19例,良4例,优良率为100%.结论了解及重视旋后内收型Ⅱ度踝骨折受伤机制,加强对胫骨远端内侧关节面高度、软骨及距骨关节面软骨受损情况的诊断及处理可有效减少骨关节炎等并发症的发生1前内侧纵行切口更有利于骨折及受损关节软骨面的暴露、关节腔脱落软骨片的清除、胫骨远端植骨关节面高度的恢复及内固定的放置.
목적 탐토급총결선후내수형Ⅱ도과관절골절적치료책략급경험.방법 2003년3월-2008년9월,대32례선후내수형Ⅱ도과관절골절진행수술치료,기중남21례,녀11례;년령21～76세,평균44.5세.기중3례위개방성골절.채취전내측입로폭로내과수직골절선급경골원단내측관절면,탐사경골원단관절면급거골연골수손정황,대탑함수손적경골원단관절면진행식골이회복기고도,내과직시하해부복위,청제관절내탈락적연골쇄편;외측인대시렬손상근거은정성정황결정시부수복,외과이위골절근거골절괴적대소급이위정도선택내고정.X선편관찰술후골절유합、내고정급시부반골성관절염정황,측량과관절활동도회복정황,동시안Maryland후족평분계통대과관절공능진행평고.결과 32례중23례획수방,시간6-47개월,평균27.9개월.1례술후5개월출현2매라정돌출피하여취출,여X선편현시무내고정송동、단렬,골절2.3～5.1개월(평균2.9개월)후균유합,수방시간내미출현골성관절염표현,과관절활동도배신위6°～17°,평균13°;척굴27°～46°,평균36°.안Maryland후족평고표준,평정우19례,량4례,우량솔위100%.결론 료해급중시선후내수형Ⅱ도과골절수상궤제,가강대경골원단내측관절면고도、연골급거골관절면연골수손정황적진단급처리가유효감소골관절염등병발증적발생1전내측종행절구경유리우골절급수손관절연골면적폭로、관절강탈락연골편적청제、경골원단식골관절면고도적회복급내고정적방치.
Objective To explore the treatment strategies for grade Ⅱ supination adduction ankle fracture. Methods From March 2003 to September 2008, 32 patients with grade Ⅱ supination adduction ankle fractures were treated surgically. There were 21 males and 11 females, at a mean age of 44.5 years (range, 21-76 years). Three patients had open ankle fractures. Anteromedial approach to the medial malleolus was taken to expose the vertical medial malleolus fractures and tibial plafond for exploring damage to distal articular surface of the tibia and that to cartilage of the talus. Open reduction and internal fixation with impaction of the articular fragment and possible bone grafting were applied to restore the height of the collapsed tibia. Medial mallcolus fractures were anatomically reduced and the intra-articular cartilage debris removed under direct vision. Repair of the lateral ligament injuries was decided acoording to the stability of the ligament. Different internal fixation was chosen according to fracture displacement of the block size and degree of lateral malleolus fractures. Fracture union, internal fixation and osteoarthritis were detected by X-ray examination. The range of ankle motion was measured. Maryland foot score was taken to assess the ankle function.Results Twenty-three patients were followed up postoperatively for a mean period of 27.9 months ( range, 6-47 months). Two prominent screws were removed from one patient five months after operation because of loosening. Bony fusion was achieved in all patients after an average period of 2.9 months ( range, 2.3-5.1 months). X-ray examination revealed no other internal fixation loosening or osteoarthritis. The average range of motion was 13 degrees of dorsiflexion (range, 6-17 degrees) and 36 degrees of plantarflexion (range, 27-46 degrees). According to Maryland foot score, ankle function was excellent in 19 patients and good in four, with excellence rate of 100%.Conclusions Understanding injury mechanism of supination adduction ankle fracture, strengthening the diagnosis and treatment of damage of tibial plafond articular surface height, cartilage and talar articular surface cartilage can effectively reduce the incidence of complications such as osteoarthritis. Anteromedial incision allows excellent exposure of the medial tibial plafond for clearance of intra-articular cartilage pieces, recovery of distal tibial articular surface height and placement of internal fixation.