CAJ | 학술논문

目的探讨踝关节骨折合并Wagstaffe骨折的诊断及治疗方法.方法 2009年1月至2012年1月,天津医院创伤骨科收治踝关节骨折患者1 201例,其中合并Wagstaffe骨折18例,男11例,女7例;年龄平均37.4(17~54)岁;摔倒伤10例,运动相关损伤4例,车祸伤3例,高处坠落伤1例.18例患者均伴有外踝骨折,其他损伤包括内踝骨折16例;内踝三角韧带完全断裂3例;后踝骨折8例.根据Lauge-hansen分型,所有骨折均为旋后-外旋型.采用外踝前方入路,外踝骨折复位后钢板内固定,Wagstaffe骨折解剖复位,拉力螺钉或丝线固定,探查及修补AITFL.内侧入路复位及固定内及后踝骨折、修复内侧三角韧带.如果下胫腓松弛,固定下胫腓联合.术后采用Baird-Jackson踝关节功能评定标准对患者踝关节功能进行评价.结果在踝关节骨折中,Wagstaffe骨折发生率为1.5%(18/1 201),在旋后-外旋型踝关节骨折中发生率为4.4%(18/411).17例获得随访,随访时间平均16.8(12~25)个月.术后平均6.7(4~8)个月X线片示踝部骨折均骨性愈合,踝穴正常,无发生创伤性关节炎.Baird-Jackson踝关节评分为81~99分,其中有优9例,良5例,可3例,优良率87.4%.14例已经恢复到伤前的活动水平,均恢复之前的工作.结论 Wagstaffe骨折容易漏诊,多见于旋后-外旋型踝关节骨折且常伴下胫腓分离.精确复位及可靠固定有助于恢复下胫腓对位及稳定.
목적 탐토과관절골절합병Wagstaffe골절적진단급치료방법.방법 2009년1월지2012년1월,천진의원창상골과수치과관절골절환자1 201례,기중합병Wagstaffe골절18례,남11례,녀7례;년령평균37.4(17~54)세;솔도상10례,운동상관손상4례,차화상3례,고처추락상1례.18례환자균반유외과골절,기타손상포괄내과골절16례;내과삼각인대완전단렬3례;후과골절8례.근거Lauge-hansen분형,소유골절균위선후-외선형.채용외과전방입로,외과골절복위후강판내고정,Wagstaffe골절해부복위,랍력라정혹사선고정,탐사급수보AITFL.내측입로복위급고정내급후과골절、수복내측삼각인대.여과하경비송이,고정하경비연합.술후채용Baird-Jackson과관절공능평정표준대환자과관절공능진행평개.결과 재과관절골절중,Wagstaffe골절발생솔위1.5%(18/1 201),재선후-외선형과관절골절중발생솔위4.4%(18/411).17례획득수방,수방시간평균16.8(12~25)개월.술후평균6.7(4~8)개월X선편시과부골절균골성유합,과혈정상,무발생창상성관절염.Baird-Jackson과관절평분위81~99분,기중유우9례,량5례,가3례,우량솔87.4%.14례이경회복도상전적활동수평,균회복지전적공작.결론 Wagstaffe골절용역루진,다견우선후-외선형과관절골절차상반하경비분리.정학복위급가고고정유조우회복하경비대위급은정.
Objective To explore the methods in the diagnosis and treatment of ankle fracture with Wagsaffe fragment. Methods Among 1 201 patients, there were 18 cases of concurrent Wagstaffe fractures at our hospital between January 2009 to January 2012. There were 11 males and 7 females with an average of 37.4 (17-54) years. The causes of injuries were fall (n=10), sports-related injury (n=4), traffic injury (n=3) and high-altitude fall (n=1). All of them had lateral malleolar fracture. Other injuries included internal malleolar fracture (n=16), posterior malleolar fracture (n=8) and disruption of medial deltoid ligament (n=3). According to the Lauge-Hansen system, all fractures were of supination-external rotation type. The fractures of fibula and Wagstaffe were explored through an anteriolateral approach. The lateral malleolar fracture was fixed with plate While Wagstaffe fragment secured with lag screw or thread. Disrupted anterior tibiofibular ligament was restored. Other treatments included open reduction and internal fixation of medial and posterior malleolus, repair of medial deltoid ligament and screw fixation of disrupted tibiotibular syndesmosis. Ankle function was evaluated by the Baird-Jackson criteria. Results Wagstaffe fracture occurred at a rate of 1.5% in ankle fractures. Wagstaffe fracture was found in 4.4% of ankle fracture of supination-external rotation type. Seventeen patients were followed up over an average follow-up period of 16.8 (12-25) months. All radiographs showed union of all fractures and normal mortises. Baird-Jackson ankle functional score was from 81 to 99. In all 17 patients, 9 were rated as excellent, 5 as good and 3 as fair. The excellent and good rate was 87.4%. At the latest follow-up, 14 patients resumed their preinjury activities. Conclusion As an easily misdiagnosed condition, Wagstaffe fracture is associated with ankle diastases and prone to occur in ankle fracture of supination-external rotation type. Accurate reduction and stable fixation facilitate the restoration of stable syndesmosis in the treatment of ankle fracture with concurrent Wagsaffe fragment.