CAJ | 학술논문

目的：探讨二孔钢板缝线装置治疗三踝骨折合并的下胫腓联合损伤的手术方式及手术临床效果。方法2010年9月至2012年9月，对利用二孔钢板缝线装置固定的三踝骨折合并的下胫腓联合损伤的11例进行连续随访观察，术后第2天即嘱患者踝关节伸屈功能锻炼，术后6周开始部分负重功能锻炼，术后12周行完全负重功能锻炼。所有患者平均随访1年，随访内容包括临床及 X 线检查，对踝关节功能行 AOFAS ( american orthopedic foot and ankle society )评分。通过术后 X 线片和标准的踝足功能评分，评估其临床效果并探讨该装置的临床应用前景。结果患者均在术后6周开始部分负重功能锻炼，术后多次的 X 线片表明，所有患者下胫腓间距在术后8周和更长时间的随访中均能保持稳定，距骨在踝穴中也无外侧位移现象，术后3个月11例 AOFAS 评分平均达60分；术后半年7例随访，平均达85分；术后1年11例随访，得分95分(满分100分)。X 线片未发现内固定失效。所有患者术后1年取出内固定装置。所有患者取出内固定时均未发现钢板切割致缝线断裂，取出内固定装置后未有不适症状复诊。结论二孔钢板缝线装置治疗下腓联合损伤具有技术简单、手术时间短、内固定器物理特性符合踝关节正常解剖、固定强度足够、避免内固定物断裂、费用较低等多项优势。
목적：탐토이공강판봉선장치치료삼과골절합병적하경비연합손상적수술방식급수술림상효과。방법2010년9월지2012년9월，대이용이공강판봉선장치고정적삼과골절합병적하경비연합손상적11례진행련속수방관찰，술후제2천즉촉환자과관절신굴공능단련，술후6주개시부분부중공능단련，술후12주행완전부중공능단련。소유환자평균수방1년，수방내용포괄림상급 X 선검사，대과관절공능행 AOFAS ( american orthopedic foot and ankle society )평분。통과술후 X 선편화표준적과족공능평분，평고기림상효과병탐토해장치적림상응용전경。결과환자균재술후6주개시부분부중공능단련，술후다차적 X 선편표명，소유환자하경비간거재술후8주화경장시간적수방중균능보지은정，거골재과혈중야무외측위이현상，술후3개월11례 AOFAS 평분평균체60분；술후반년7례수방，평균체85분；술후1년11례수방，득분95분(만분100분)。X 선편미발현내고정실효。소유환자술후1년취출내고정장치。소유환자취출내고정시균미발현강판절할치봉선단렬，취출내고정장치후미유불괄증상복진。결론이공강판봉선장치치료하비연합손상구유기술간단、수술시간단、내고정기물리특성부합과관절정상해부、고정강도족구、피면내고정물단렬、비용교저등다항우세。
Objective To investigate the operative method in the treatment of trimalleolar ankle fractures combined with distal tibiofibular syndesmosis injuries by using 2-hole plate and suture complex, and to evaluate clinical results.Methods Eleven patients with trimalleolar ankle fractures combined with distal tibiofibular syndesmosis injuries were treated by 2-hole plate and suture complex from September 2010 to September 2012, and then were followed up. The patients were encouraged to perform active ankle lfexion-extension movement at 2 days after the operation, partial weight-bearing functional exercise at 6 days after the operation, and full weight-bearing functional exercise at 12 days after the operation. The average follow-up period was 12 months. The clinical examination, radiographic analysis and American Orthopedic Foot and Ankle Society ( AOFAS ) ankle-hindfoot scale were used to evaluate the outcomes. According to the patients’ postoperative radiographic data and ankle-hindfoot scores, the clinical results of this new ifxation complex were evaluated and its application prospects were discussed. Results All the patients began their partial weight-bearing functional exercise at 6 weeks after the operation. The postoperative X-ray analysis demonstrated the tibioifbular clear space ( TFCS ) remained stable in all the patients from the 8th week after the operation to the subsequent follow-up. Meanwhile, there was no evidence of displacement in the lateral talus within the ankle mortise. The mean AOFAS score at 3 months after the operation was 60 points in 11 patients, which was 85 points in 7 patients who had the follow-up visit at 6 months after the operation. The AOFAS scores obtained at 12 months after the operation in all the patients were excellent, which was 95 points on average out of 100 points. The plain X-ray measurement showed no loosening of 2-hole plate and suture complex ifxation. The internal ifxation devices in all the patients were removed at 12 months after the implantation. There were no broken sutures caused by plate cutting when the implants were removed in all patients. No patients complained of any discomfort after the removal.Conclusions Two-hole plate and suture complex for trimalleolar ankle fractures combined with distal tibioifbular syndesmosis injuries has such advantages as easier operative techniques, shorter operation time, better physical properties, enough ifxation strength, avoidance of the breakage of internal ifxation andless cost.