天津医药
天津醫藥
천진의약
TIANJIN MEDICAL JOURNAL
2015年
9期
1059-1062
,共4页
王言青%刘明辉%田学忠%贾世孔
王言青%劉明輝%田學忠%賈世孔
왕언청%류명휘%전학충%가세공
骨折%骨折固定术,内%踝关节骨折%旋后内收型
骨摺%骨摺固定術,內%踝關節骨摺%鏇後內收型
골절%골절고정술,내%과관절골절%선후내수형
fractures,bone%fracture fixation,internal%ankle fracture%supination adduction
目的：探讨双钢板治疗合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折的疗效。方法选择17例合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折患者，踝关节前内侧入路直视下复位内踝及胫骨远端塌陷关节面，植骨支撑，于胫骨远端前内侧行桡骨远端钢板支撑固定，在软骨下骨区打入3枚螺钉，对塌陷的关节面实现直接坚强固定，内踝行防滑钢板固定。腓骨骨折予重建钢板固定。术后定期复查X线片观察骨折愈合情况，采用美国足踝外科医师协会（AOFAS）踝-后足评分系统对踝关节功能进行评估。结果横断位CT研究发现12例（70.6%）塌陷关节面主要位于胫骨远端前内侧1/4关节面区，以前缘最严重。5例（29.4%）塌陷区仅位于胫骨前内缘，关节面中部无累及。17例中16例获得随访，平均（2.6±0.9）年，骨折平均（2.9±0.5）个月愈合。X线片未出现内固定松动断裂，胫骨远端关节面复位无丢失。踝关节活动度背伸平均16.4°±2.8°，跖屈平均39.2°±5.3°。按AOFAS踝-后足评分系统，优14例，良2例，优良率100%。结论双钢板治疗合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折可以对胫骨远端关节面充分支撑固定，减少复位丢失，降低创伤性关节炎的发生率。
目的：探討雙鋼闆治療閤併脛骨遠耑關節麵壓縮的鏇後內收型Ⅱ度踝關節骨摺的療效。方法選擇17例閤併脛骨遠耑關節麵壓縮的鏇後內收型Ⅱ度踝關節骨摺患者，踝關節前內側入路直視下複位內踝及脛骨遠耑塌陷關節麵，植骨支撐，于脛骨遠耑前內側行橈骨遠耑鋼闆支撐固定，在軟骨下骨區打入3枚螺釘，對塌陷的關節麵實現直接堅彊固定，內踝行防滑鋼闆固定。腓骨骨摺予重建鋼闆固定。術後定期複查X線片觀察骨摺愈閤情況，採用美國足踝外科醫師協會（AOFAS）踝-後足評分繫統對踝關節功能進行評估。結果橫斷位CT研究髮現12例（70.6%）塌陷關節麵主要位于脛骨遠耑前內側1/4關節麵區，以前緣最嚴重。5例（29.4%）塌陷區僅位于脛骨前內緣，關節麵中部無纍及。17例中16例穫得隨訪，平均（2.6±0.9）年，骨摺平均（2.9±0.5）箇月愈閤。X線片未齣現內固定鬆動斷裂，脛骨遠耑關節麵複位無丟失。踝關節活動度揹伸平均16.4°±2.8°，蹠屈平均39.2°±5.3°。按AOFAS踝-後足評分繫統，優14例，良2例，優良率100%。結論雙鋼闆治療閤併脛骨遠耑關節麵壓縮的鏇後內收型Ⅱ度踝關節骨摺可以對脛骨遠耑關節麵充分支撐固定，減少複位丟失，降低創傷性關節炎的髮生率。
목적：탐토쌍강판치료합병경골원단관절면압축적선후내수형Ⅱ도과관절골절적료효。방법선택17례합병경골원단관절면압축적선후내수형Ⅱ도과관절골절환자，과관절전내측입로직시하복위내과급경골원단탑함관절면，식골지탱，우경골원단전내측행뇨골원단강판지탱고정，재연골하골구타입3매라정，대탑함적관절면실현직접견강고정，내과행방활강판고정。비골골절여중건강판고정。술후정기복사X선편관찰골절유합정황，채용미국족과외과의사협회（AOFAS）과-후족평분계통대과관절공능진행평고。결과횡단위CT연구발현12례（70.6%）탑함관절면주요위우경골원단전내측1/4관절면구，이전연최엄중。5례（29.4%）탑함구부위우경골전내연，관절면중부무루급。17례중16례획득수방，평균（2.6±0.9）년，골절평균（2.9±0.5）개월유합。X선편미출현내고정송동단렬，경골원단관절면복위무주실。과관절활동도배신평균16.4°±2.8°，척굴평균39.2°±5.3°。안AOFAS과-후족평분계통，우14례，량2례，우량솔100%。결론쌍강판치료합병경골원단관절면압축적선후내수형Ⅱ도과관절골절가이대경골원단관절면충분지탱고정，감소복위주실，강저창상성관절염적발생솔。
Objective To evaluate the effect of double-plate treatment on grade Ⅱsupination adduction ankle frac? tures with impaction of tibial plafond. Methods A total of 17 patients of gradeⅡsupination adduction ankle fractures with impaction of tibial plafond were treated surgically in our hospital. Anteromedial approach to the medial malleolus was taken to expose the tibial plafond and the vertical medial malleolus fractures. One distal radius plate was placed on the anteromei?dal tibial plafond, and another buttress plate was placed on the medial malleolus. Bone grafting was used to restore the height of the collapsed tibia. Lateral malleolus fractures were treated with reconstruction plate. The fracture union after operation was detected by X-ray examination. American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score was used to assess the ankle function. Results Sixteen of 17 patients were followed up postoperatively for a mean period of 2.6 ± 0.9 years. CT cross-sectional study found that the collapsed articular surface of 12 (70.6%) patients was mainly located in the an?teromedial one-fourth area, with the worst at anterior margin. Bony fusion was achieved in all patients after an average peri?od of 2.9±0.5 months. No internal fixation loosening or fracture redisplacement was found by X-ray. The average range of an?kle joint activity was 16.4°±2.8° for dorsiflexion, and was 39.2°±5.3° for plantarflexion. According to AOFAS ankle hindfoot scale, ankle function was excellent in 14 patients and good in 2, with excellence rate of 100%. Conclusion The application of double-plate fixation to treat gradeⅡsupination adduction ankle fractures with impaction of tibial plafond can play a key role in reducing fracture redisplacement and osteoarthritis.
