中国骨科临床与基础研究杂志
中國骨科臨床與基礎研究雜誌
중국골과림상여기출연구잡지
CHINESE JOURNAL OF CLINICAL AND BASIC ORTHO[AEDIC RESEARCH
2014年
5期
286-290
,共5页
踝关节%踝损伤%脱位%软组织损伤%骨折固定术%外固定器
踝關節%踝損傷%脫位%軟組織損傷%骨摺固定術%外固定器
과관절%과손상%탈위%연조직손상%골절고정술%외고정기
Ankle joint%Ankle injuries%Dislocations%Soft tissue injuries%Fracture fixation%External fixators
目的：探讨单侧组合式外固定架治疗踝关节骨折脱位并软组织缺损的疗效。方法回顾性分析2008年7月至2012年7月广东医学院附属医院收治的15例踝关节骨折脱位并软组织缺损患者的临床资料。入院行急诊清创、单侧组合式外固定架固定，创面二期修复，术后定期复查X线片，根据美国骨科足踝外科协会（AOFAS）踝关节功能评分系统对患者末次随访时踝关节功能进行评分。结果手术时间40～120 min，平均手术时间（79±24）min；邮票植皮13例、皮瓣移植2例，均全部成活；创面愈合时间17～42 d，平均愈合时间（23±7）d；随访时间12～36个月，平均随访时间（20±6）个月。无皮肤坏死、骨髓炎，无固定针松动、外固定失效等并发症；3例发生轻度针道及克氏针感染，对症处理后治愈。术后骨性愈合时间5～11个月，平均愈合时间（8.2±1.8）个月。末次随访时AOFAS踝关节功能评分：优9例、良4例、一般2例。结论对于踝关节骨折脱位并软组织缺损患者，单侧组合式外固定架可实现跨关节固定，具有固定牢靠、创面修复迅速、允许早期负重和功能锻炼等优点。
目的：探討單側組閤式外固定架治療踝關節骨摺脫位併軟組織缺損的療效。方法迴顧性分析2008年7月至2012年7月廣東醫學院附屬醫院收治的15例踝關節骨摺脫位併軟組織缺損患者的臨床資料。入院行急診清創、單側組閤式外固定架固定，創麵二期脩複，術後定期複查X線片，根據美國骨科足踝外科協會（AOFAS）踝關節功能評分繫統對患者末次隨訪時踝關節功能進行評分。結果手術時間40～120 min，平均手術時間（79±24）min；郵票植皮13例、皮瓣移植2例，均全部成活；創麵愈閤時間17～42 d，平均愈閤時間（23±7）d；隨訪時間12～36箇月，平均隨訪時間（20±6）箇月。無皮膚壞死、骨髓炎，無固定針鬆動、外固定失效等併髮癥；3例髮生輕度針道及剋氏針感染，對癥處理後治愈。術後骨性愈閤時間5～11箇月，平均愈閤時間（8.2±1.8）箇月。末次隨訪時AOFAS踝關節功能評分：優9例、良4例、一般2例。結論對于踝關節骨摺脫位併軟組織缺損患者，單側組閤式外固定架可實現跨關節固定，具有固定牢靠、創麵脩複迅速、允許早期負重和功能鍛煉等優點。
목적：탐토단측조합식외고정가치료과관절골절탈위병연조직결손적료효。방법회고성분석2008년7월지2012년7월엄동의학원부속의원수치적15례과관절골절탈위병연조직결손환자적림상자료。입원행급진청창、단측조합식외고정가고정，창면이기수복，술후정기복사X선편，근거미국골과족과외과협회（AOFAS）과관절공능평분계통대환자말차수방시과관절공능진행평분。결과수술시간40～120 min，평균수술시간（79±24）min；유표식피13례、피판이식2례，균전부성활；창면유합시간17～42 d，평균유합시간（23±7）d；수방시간12～36개월，평균수방시간（20±6）개월。무피부배사、골수염，무고정침송동、외고정실효등병발증；3례발생경도침도급극씨침감염，대증처리후치유。술후골성유합시간5～11개월，평균유합시간（8.2±1.8）개월。말차수방시AOFAS과관절공능평분：우9례、량4례、일반2례。결론대우과관절골절탈위병연조직결손환자，단측조합식외고정가가실현과관절고정，구유고정뢰고、창면수복신속、윤허조기부중화공능단련등우점。
Objective To evaluate the outcome of unilateral composite external fixator for the treatment of fracture-dislocation of ankle joint with soft tissue defect. Methods From July 2008 to July 2012, 15 patients suffered from fracture-dislocation of ankle joint with soft tissue defect were treated in the Affiliated Hospital of Guangdong Medical College. All patients received emergency surgery of debridement and external fixation with unilateral composite external fixator after admission, and the open wound achieved two-stage repair. X-ray were taken for follow-up after the surgery, and at the last follow-up, function of ankle joint was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scoring. Results The average operative time was (79 ± 24) min (40-120 min). There were stamp skin grafting in 13 cases and flap transplantation in 2 cases, and skin graft survived in all patients. The average wound healing time was(23 ± 7)d ( 17-42 d), and the average follow-up was (20 ± 6) months (12-36 months). No necrosis of skin, osteomyelitis, pin loosening or external fixation failure occurred. There were only 3 patients of mild infection of pin site or Kirschner wire who were cured shortly after symptomatic therapy. The average bone union time was (8.2 ± 1.8) months (5-11 months). According to AOFAS scoring, there were excellent in 9 cases, good in 4 cases and fair in 2 cases at the last follow-up. Conclusion For fracture-dislocation of ankle joint with soft tissue defect, unilateral composite external fixator allows for transarticular fixation, rapid wound repair, as well as early weight-bearing and functional excise..
