CAJ | 학술논문

目的：探讨采用直接入路治疗三踝骨折的临床疗效。方法2000年1月~2012年1月采用直接入路内固定治疗的47例三踝骨折患者。根据骨折方式和软组织损伤情况制定直接入路手术方案。术后采用Burwell-Charn_ley标准评估骨折复位情况，采用AOFAS踝后足评分和VAS评分进行临床评估。结果本组47例患者平均随访时间24.2月(10~45月)，骨折愈合时间平均13.6周(10~26周)。按Burwell-Charnley标准，本组优23例，良16例，中6例，差2例，优良率82.98%(39/47)。平均AOFAS评分86.5分(71~97分)；平均VAS评分1.4分(0~6分)。4例发生浅表感染，局部换药后治愈；2例开放性骨折出现深部感染，去除内固定改为外固定支架固定后治愈；3例患者出现轻度的畸形愈合；4例延迟愈合；10例患者X线有不同程度的关节退变，其中2例因关节炎程度较重伴有长期疼痛进行了关节融合，其余患者X线虽有关节炎表现但踝关节功能良好。结论直接入路治疗三踝骨折的临床疗效令人满意。
목적：탐토채용직접입로치료삼과골절적림상료효。방법2000년1월~2012년1월채용직접입로내고정치료적47례삼과골절환자。근거골절방식화연조직손상정황제정직접입로수술방안。술후채용Burwell-Charn_ley표준평고골절복위정황，채용AOFAS과후족평분화VAS평분진행림상평고。결과본조47례환자평균수방시간24.2월(10~45월)，골절유합시간평균13.6주(10~26주)。안Burwell-Charnley표준，본조우23례，량16례，중6례，차2례，우량솔82.98%(39/47)。평균AOFAS평분86.5분(71~97분)；평균VAS평분1.4분(0~6분)。4례발생천표감염，국부환약후치유；2례개방성골절출현심부감염，거제내고정개위외고정지가고정후치유；3례환자출현경도적기형유합；4례연지유합；10례환자X선유불동정도적관절퇴변，기중2례인관절염정도교중반유장기동통진행료관절융합，기여환자X선수유관절염표현단과관절공능량호。결론직접입로치료삼과골절적림상료효령인만의。
Objective To explore the clinical outcomes of treatment of trimalleolar fractures through direct approache. Methods 47 patients with trimalleolar fractures from January 2000 and January 2012 were treated by internal fixation through specific direct approaches. A detailed surgical plan of specific approaches was made by considering the specific fracture patterns and soft tissue injury condition. The Burwell-Charnley scale was used to evaluate the quality of fracture reduction and the American Orthopaedic Foot and Ankle So_ciety ( AOFAS) ankle-hindfoot score and the Visual Analogue Scale ( VAS) were used to evaluate the func_tional outcomes. Results The mean follow-up time of all 47 patients was 24. 2 months ( range: 10 to 45 months). All fractures healed at an average of 13. 6 weeks (range:10 to 26 weeks). The outcomes were excellent in 23 cases, good in 16, fair in 6, and poor in 2, and the excellent-good rate was 82. 98%(39/47) according to the Burwell-Charnley criteria. The mean of AOFAS score was 86. 5 points ( range:71 to 97 points), and the mean of VAS score was 1. 4 points (range:0 to 6 points). Superficial wound infection occurred in 4 patients, which healed with local treatments. Deep tissue infection was found in 2 patients with open fracture, which healed by substituting the external fixation for implanted metalwork. Malunion occurred in 3 patients and delayed union occurred in 4 patients. Posttraumatic arthritis was found in 10 patients with the radiographic examination, 2 of whom underwent arthrodesis because of the long-term pain and bad func_tion, others with the existence of arthritis have good function of the ankle. Conclusion The clinical outcomes of the treatment of trimalleolar fractures are satisfactory through the direct approach.