CAJ | 학술논문

目的：探讨固定后踝骨折后对下胫腓联合稳定性的影响。方法2009年3月至2014年4月我院对28例后踝骨折合并下胫腓联合损伤的患者采用后外侧入路钢板固定后踝骨折，术中透视下作拉钩试验检查下胫腓联合的稳定性以决定是否需要应用下胫腓螺钉。其中男13例，女15例，年龄25~64岁，平均44.1岁；左侧骨折12例，右侧骨折16例。交通伤9例，跌倒扭伤19例。28例患者全部为新鲜闭合骨折。按照 Lauge-Hasen 分型，旋后外旋型Ⅲ度3例，旋后外旋型Ⅳ度20例，旋前外旋型Ⅳ度 5例。所有患者均同时有腓骨远段和后踝的骨折，其中25例存在内踝骨折，5例为踝关节骨折脱位。结果27例患者因后踝骨折得到稳定固定后不需要再应用下胫腓螺钉，1例即使固定后踝骨折下胫腓仍不稳定，需加用下胫腓螺钉。术后随防7~26个月，平均16.3个月。骨折平均愈合时间平均6.5个月。按 Olerud 和 Molander 踝关节骨折术后功能评分系统进行评分，其中优（90~100分）23例，良（80~89分）3例，可（<80分）2例，平均93分，优良率为92.9%。结论合并下胫腓联合损伤时固定后踝骨折能增强下胫腓联合的稳定性及减少应用下胫腓螺钉的概率，临床中应重视后踝骨折的处理。
목적：탐토고정후과골절후대하경비연합은정성적영향。방법2009년3월지2014년4월아원대28례후과골절합병하경비연합손상적환자채용후외측입로강판고정후과골절，술중투시하작랍구시험검사하경비연합적은정성이결정시부수요응용하경비라정。기중남13례，녀15례，년령25~64세，평균44.1세；좌측골절12례，우측골절16례。교통상9례，질도뉴상19례。28례환자전부위신선폐합골절。안조 Lauge-Hasen 분형，선후외선형Ⅲ도3례，선후외선형Ⅳ도20례，선전외선형Ⅳ도 5례。소유환자균동시유비골원단화후과적골절，기중25례존재내과골절，5례위과관절골절탈위。결과27례환자인후과골절득도은정고정후불수요재응용하경비라정，1례즉사고정후과골절하경비잉불은정，수가용하경비라정。술후수방7~26개월，평균16.3개월。골절평균유합시간평균6.5개월。안 Olerud 화 Molander 과관절골절술후공능평분계통진행평분，기중우（90~100분）23례，량（80~89분）3례，가（<80분）2례，평균93분，우량솔위92.9%。결론합병하경비연합손상시고정후과골절능증강하경비연합적은정성급감소응용하경비라정적개솔，림상중응중시후과골절적처리。
Objective To explore the effect of the posterior malleolar fixation on syndesmotic stability. Methods From March 2009 to April 2014,28 patients with posterior malleolar fractures and syndesmotic injuries underwent open reduction and internal fixation via the posterolateral approach. After posterior malleolar fixation,Hook-text was done to check the syndesmosis stability in order to decide whether dyndesmotic screws should be used. According to the Lauge-Hansen classification system, the cases include:3 of them were stage Ⅲ supination-external rotation(SER). 20 of them were stage IV supination-external ro-tation(SER),the other 5 of them were stage IV pronation-external rotation(PER). All patients had distal fibula and posterior malleolar fractures,and among them 25 had medial malleolar fractures and 5 had fracture dislacation of ankle joints. Results After fixation of the posterior malleolar fractures,27 patients got syndesmotic stability obtained,so no syndesmotic screw were needed. 1 patient still needed syndesmotic screws because of syndesmotic unstability. The average duration of the follow-up was 16. 3 months(7 ~ 26 monthes). The average time of bone union was 6. 5 monthes. The results were graded according to the score system of Olerud and Molander,23 cases were rated excellent(90 ~ 100),3 good(80 ~ 89),2 fair( < 80),the average point was 93. The rate of excellent and good was 92. 9% . Conclusion Fixation of the posterior malleolar enhance the syndes-motic stability and reduce the usage of a syndesmotic screw. More attention should be paid on dealing with posterior malleolar.