CAJ | 학술논문

目的探讨应用腓骨钩状钢板治疗腓骨远端不稳定骨折的经验及临床疗效.方法 2006年1月至2009年1月,对28例伴有腓骨远端粉碎性骨折的踝部骨折行切开复位内固定术,其中19例得到完整随访,男12例,女7例;年龄18～72岁,平均36岁;单纯外踝骨折4例,双踝骨折9例,三踝骨折6例.按Danis-Weber分类,A型8例,B型11例,均为腓骨远端不稳定粉碎性骨折.受伤至接受手术的时间为6h至16d,平均6d.手术顺序为外踝、后踝和内踝.外踝骨折使用腓骨钩状钢板固定,内踝骨折使用松质骨螺钉,后踝骨折根据骨折块大小及形态采用螺钉或钢板固定.结果术后随访6～32个月,平均18.8个月.术后4～6周X线片均可见骨折线模糊;10例患者于术后12周达到临床愈合,9例于术后20周达到临床愈合.伤口均一期愈合,无一例发生感染、局部不良反应及踝关节不稳.Mazur评分为67～92分,平均86.3分,其中优12例,良4例,可2例,差1例,优良率为84.2%.结论运用腓骨钩状钢板固定外踝骨折能更好恢复外踝正常外翻角及长度等解剖结构,并有效固定,为早期活动提供稳定性,利于踝关节功能恢复.
목적 탐토응용비골구상강판치료비골원단불은정골절적경험급림상료효.방법 2006년1월지2009년1월,대28례반유비골원단분쇄성골절적과부골절행절개복위내고정술,기중19례득도완정수방,남12례,녀7례;년령18～72세,평균36세;단순외과골절4례,쌍과골절9례,삼과골절6례.안Danis-Weber분류,A형8례,B형11례,균위비골원단불은정분쇄성골절.수상지접수수술적시간위6h지16d,평균6d.수술순서위외과、후과화내과.외과골절사용비골구상강판고정,내과골절사용송질골라정,후과골절근거골절괴대소급형태채용라정혹강판고정.결과 술후수방6～32개월,평균18.8개월.술후4～6주X선편균가견골절선모호;10례환자우술후12주체도림상유합,9례우술후20주체도림상유합.상구균일기유합,무일례발생감염、국부불량반응급과관절불은.Mazur평분위67～92분,평균86.3분,기중우12례,량4례,가2례,차1례,우량솔위84.2%.결론 운용비골구상강판고정외과골절능경호회복외과정상외번각급장도등해부결구,병유효고정,위조기활동제공은정성,리우과관절공능회복.
Objective To evaluate the clinical outcome of lateral malleolar's anatomical hook-plate in treating ankle fracture including distal fibular fracture. Methods Nineteen patients of ankle fracture including distal fibular fracture were treated from January 2006 to January 2009. There were 12 males and 7 females with an average age of 36 years (range, 18-72 years). The fractures were classified by Danis-Weber system. There were A type in 8 cases, B type in 11 cases. The average time of duration between injury and operation was 6 days (ranged from 6 hours to 16 days). The distal fibular fracture were treated with lateral malleolar's anatomical hook-plate. The medial malleolus was fixed with cancellous bone screw. The posterior malleolus was fixed with screw or plate according to the pattern of fracture. Results The mean follow-up period was 18.8 months with a range from 6 to 32 months. No obvious fracture line could be seen on the radiographs 4-6 weeks after operation. Bone healing was achieved in 10 cases 12 weeks after operation and in 9 cases 20 weeks after operation. All surgical incisions healed adequately. There were no instances of infection, instability of ankle and other complications. According to Mazur ankle joint scoring scale system, the fiual result was scored from 67 to 92 (average 86.3). There were excellent in 12 cases, good in 4, fair in 2,and poor in 1 case. The excellent and good rate was 84.2%. Conclusion The lateral malleolar's anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus, with advantage of restoring anatomic structure, joint activity effectively and firm fixation.