CAJ | 학술논문

目的探讨踝关节骨折合并Tillaux-Chaput和Volkmann骨折的临床特点及治疗方法.方法 2005年9月至2012年1月采用手术治疗并获得随访的踝关节骨折合并Tillaux-Chaput和Volkmann骨折患者15例,男8例,女7例；年龄16～57岁,平均27.3岁；均为内踝、腓骨骨折合并Tillaux-Chaput和Volkmann骨折.8例Tillaux-Chaput骨折经X线片确诊,7例经CT扫描确诊.依据踝关节骨折Lauge-Hansen分型,旋前外展型Ⅲ度11例,旋前外旋型Ⅳ度4例.采用后外侧入路,复位腓骨骨折后以钢板固定,复位Volkmann骨折后以1～2枚空心螺钉固定；采用内侧弧形切口显露内踝骨折,复位后以空心螺钉固定；于胫骨前结节做纵行切口,复位Tillaux-Chaput骨折后以空心螺钉固定.根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价踝关节功能.结果随访8 ～20个月,平均12.5个月.骨折均愈合,愈合时间12～36周,平均23.5周.末次随访时12例行走正常,3例轻度跛行. AOFAS评分71～94分,平均85.4分；其中优9例、良4例、可2例,优良率86.7％(13/15).3例踝关节活动受限,3例下地负重行走时疼痛不适.结论 Tillaux-Chaput及Volkman骨折多发生于旋前外展型踝关节骨折时,X线检查容易漏诊,CT检查可明确诊断,手术治疗要求精确复位及固定.
목적 탐토과관절골절합병Tillaux-Chaput화Volkmann골절적림상특점급치료방법.방법 2005년9월지2012년1월채용수술치료병획득수방적과관절골절합병Tillaux-Chaput화Volkmann골절환자15례,남8례,녀7례；년령16～57세,평균27.3세；균위내과、비골골절합병Tillaux-Chaput화Volkmann골절.8례Tillaux-Chaput골절경X선편학진,7례경CT소묘학진.의거과관절골절Lauge-Hansen분형,선전외전형Ⅲ도11례,선전외선형Ⅳ도4례.채용후외측입로,복위비골골절후이강판고정,복위Volkmann골절후이1～2매공심라정고정；채용내측호형절구현로내과골절,복위후이공심라정고정；우경골전결절주종행절구,복위Tillaux-Chaput골절후이공심라정고정.근거미국족과외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)과여후족평분표준평개과관절공능.결과 수방8 ～20개월,평균12.5개월.골절균유합,유합시간12～36주,평균23.5주.말차수방시12례행주정상,3례경도파행. AOFAS평분71～94분,평균85.4분；기중우9례、량4례、가2례,우량솔86.7％(13/15).3례과관절활동수한,3례하지부중행주시동통불괄.결론 Tillaux-Chaput급Volkman골절다발생우선전외전형과관절골절시,X선검사용역루진,CT검사가명학진단,수술치료요구정학복위급고정.
Objective To explore the clinical characteristics and operative methods of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Methods The data of 15 patients who were suffered the ankle fracture combined with the simultaneous fractures of Tillaux-Chaput and Volkmann between Septenber 2005 and January 2012 were analyzed.There were 8 males and 7 females with an average age of 27.3 years (range,16-57 years).All had medial malleolar and fibular fracture with Tillaux-Chaput and Volkmann tubercle avulsed fracture.X-ray film shows that there were 8 cases in which the patients had Tillaux-Chaput fracture,among whom 7 were diagnosed by CT scan.Classified by Lauge-Hansen system,ankle fracture could be divided into pronation-exterual rotation type in 4 cases,and pronation-abduction type in 11 cases.The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach.The fibular fracture was fixed with plate.The medial malleolar fracture was explored from medial curve approach.Tillaux-Chaput fracture was treated by the mierotubule cut.All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS).Results All patients were followed up for 8-20 months (average,12.5 months).The fracture healed 12-36 weeks later in all the 15 patients,with an average of 23.5 weeks.Twelve patients walked normally and 3 with mild claudication in the last follow-up.The AOFAS score was average 85.4 points,9 were excellent,4 were good,2were fair,with the good-excellent rate being 86.7％ (13/15).The movement of ankle joint limited in 3 patients,tenderness occurred when weight bearing in 3 patients.Conclusion The ankle fracture include the simultaneous fractures of Tillaux-Chaput and Volkmann were more seen in the type of pronation-abduction.It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments.The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Inferior tibia fibular screw was not routinely used in this fracture.