CAJ | 학술논문

目的：探讨累及后踝的踝关节骨折的损伤机制、手术方法和治疗效果。方法自2008年7月至2012年3月间，手术治疗累及后踝的踝关节骨折共42例，男30例，女12例，应用 Lauge_Hansen 分类，旋后外旋型21例，旋前外旋型12例，旋前外展型9例。后踝骨折根据 CT 分类，Ⅰ型22例，Ⅱ型12例，Ⅲ型8例。后踝骨折根据骨块大小和关节面的塌陷情况，采用后侧支撑钢板或多枚拉力螺钉固定。结果42例均获随访，随访时间12~24个月，骨折愈合时间10~18周。根据美国足与踝关节协会（American orthopaedic foot and ankle society，AOFAS）评分，优21例，良15例，可6例，优良率为85.7％。结论累及后踝的踝关节骨折，常伴有胫骨远端关节面塌陷和踝关节后脱位或半脱位，根据骨折类型选择手术方式和固定方法，可保证踝关节获得解剖复位，最大限度恢复踝关节功能。
목적：탐토루급후과적과관절골절적손상궤제、수술방법화치료효과。방법자2008년7월지2012년3월간，수술치료루급후과적과관절골절공42례，남30례，녀12례，응용 Lauge_Hansen 분류，선후외선형21례，선전외선형12례，선전외전형9례。후과골절근거 CT 분류，Ⅰ형22례，Ⅱ형12례，Ⅲ형8례。후과골절근거골괴대소화관절면적탑함정황，채용후측지탱강판혹다매랍력라정고정。결과42례균획수방，수방시간12~24개월，골절유합시간10~18주。근거미국족여과관절협회（American orthopaedic foot and ankle society，AOFAS）평분，우21례，량15례，가6례，우량솔위85.7％。결론루급후과적과관절골절，상반유경골원단관절면탑함화과관절후탈위혹반탈위，근거골절류형선택수술방식화고정방법，가보증과관절획득해부복위，최대한도회복과관절공능。
Objective To investigate the mechanism of the injury,surgical treatment and the outcome of the anklebone fracture extended to posterior malleolus. Methods Between July 2008 to March 2012,42 patients with posterior malleolus fractures were surgical treated,including 30 males and 12 females. Fracture were classified with Lauge_Hansen classification system;supination_external rotation,pronation_external and pronation_abduction rotation accounted for 21,12 and 9 cases. Ac_cording to CT scan classification,the group was made up of 22 typeⅠ cases,12 typeⅡand 8 type Ⅲ cases. Internal fixation were accomplished by buttress plate and / or multiple_canulated screws which was decided upon the severity of osteochondral fragment impaction at posterior tibial platform. Results The postoperative follow_up period was 12 to 24 months. All the inci_sions were healed uneventfully,and fractures were healed in 10 to 18 weeks postoperatively. According to American Orthopae_dic Foot and Ankle Society(AOFAS),the results of ankle and hindfoot score were excellent in 21 cases,good in 15,and fair in 6 with an excellent and good rate of 85. 7% . Conclusion Anklebone fracture extended to posterior malleolus is combined with the impaction of posteromedial tibial plafond and ankle joint disassociation. According to different types of posterior malleolus fractures of ankle joint,the best treatment and fixation methods will be chosen. The open reduction and internal fixation can en_sure anatomic joint restoration and union for the posterior malleolus fractures of ankle joint,and achieve most satisfied kinemat_ics function of the ankle joint.