内踝解剖型钩钢板治疗粉碎性内踝骨折的疗效分析
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摘要
目的评价内踝解剖型钩钢板治疗粉碎性内踝骨折的临床疗效。方法对2015年3月至2017年6月采用内踝解剖型钩钢板治疗粉碎性内踝骨折的30例病人进行回顾性分析,其中男18例,女12例;年龄为21~50岁,平均34.5岁。受伤原因:扭伤10例,直接暴力骨折20例。左踝12例,右踝18例。30例病人均行切开复位内固定手术,内踝应用解剖型钩钢板固定,合并外踝及后踝骨折的病人,外踝应用解剖钢板固定,后踝应用空心螺钉或钢板固定。采用美国足踝外科医师协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统、踝关节活动度和疼痛视觉模拟评分量表(visual analogue scale,VAS)评价术前及末次随访时病人的踝关节功能。结果所有30例病人的随访时间为6~18个月,平均13.1个月。术后切口均一期甲级愈合,无感染、皮瓣坏死、骨折移位、内固定松动、骨不愈合等并发症出现。手术前后的AOFAS踝-后足评分分别为(12.0±10.0)分、(90.0±3.1)分,VAS评分分别为(5.4±1.0)分、(1.3±0.3)分,差异均有统计学意义(P均<0.05)。末次随访时平均踝关节活动度为60.2°±6.2°。结论采用内踝解剖型钩钢板治疗粉碎性内踝骨折,固定牢固,操作方便,病人术后功能恢复好,是治疗粉碎性内踝骨折有效的固定方法。
Objective To evaluate the clinical results of the medial malleolar communited fracture with fixation of the anatomical hook plate. Methods Between March 2015 and June 2017, 30 patients with comminuted fracture of the medial malleolus were treated by using the anatomic hook plate. There were 18 male and 12 female patients with an average age of 34.5 years(range, 21-50 years). Fractures were caused due to ankle sprain in 10 cases and due to direct impact force in 20 cases. Twelve cases were involved in left ankle and the rest 18 cases in right ankle. All the patients received open reduction and internal fixation. The medial malleolar fracture was fixed by the anatomical hook plate. In cases of associated lateral and posterior malleolar fracture, the lateral malleolar fracture was fixed by anatomical locking plate and the posterior malleolar fragment was fixed by either lag screws or plate. The AOFAS Ankle Hindfoot Score, visual analogue score(VAS) score and ankle range of motion were evaluated preoperatively and at the last follow-up. Results The mean follow-up duration was 13.1 months(range 6-18 months). There were no wound infection, skin flap necrosis, displacement of the fracture, loosening of the internal fixation and nonunion after the surgery. The AOFAS score was increased from 12.0±10.0 preoperatively to 90.0±3.1 postoperatively. The VAS score was reduced from 5.4±1.0 preoperatively to 1.3±0.3 postoperatively. The mean ankle range of motion was 60.2°±6.2° at the last follow-up. Conclusion Fixation of the medial malleolar comminuted fracture by the anatomical hook plate is an effective way due to the achievement of reliable fixation and good functional recovery.
Objective To evaluate the clinical results of the medial malleolar communited fracture with fixation of the anatomical hook plate. Methods Between March 2015 and June 2017, 30 patients with comminuted fracture of the medial malleolus were treated by using the anatomic hook plate. There were 18 male and 12 female patients with an average age of 34.5 years(range, 21-50 years). Fractures were caused due to ankle sprain in 10 cases and due to direct impact force in 20 cases. Twelve cases were involved in left ankle and the rest 18 cases in right ankle. All the patients received open reduction and internal fixation. The medial malleolar fracture was fixed by the anatomical hook plate. In cases of associated lateral and posterior malleolar fracture, the lateral malleolar fracture was fixed by anatomical locking plate and the posterior malleolar fragment was fixed by either lag screws or plate. The AOFAS Ankle Hindfoot Score, visual analogue score(VAS) score and ankle range of motion were evaluated preoperatively and at the last follow-up. Results The mean follow-up duration was 13.1 months(range 6-18 months). There were no wound infection, skin flap necrosis, displacement of the fracture, loosening of the internal fixation and nonunion after the surgery. The AOFAS score was increased from 12.0±10.0 preoperatively to 90.0±3.1 postoperatively. The VAS score was reduced from 5.4±1.0 preoperatively to 1.3±0.3 postoperatively. The mean ankle range of motion was 60.2°±6.2° at the last follow-up. Conclusion Fixation of the medial malleolar comminuted fracture by the anatomical hook plate is an effective way due to the achievement of reliable fixation and good functional recovery.
引文
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[12]孙涛,王丹,周智勇,等.外踝解剖型钩状钢板在Weber A型踝部骨折固定中的生物力学分析[J].中国修复重建外科杂志,2008,22(7):824-827.
[2]姜保国.踝关节骨折治疗进展[J].中华创伤杂志,2008,24(5):321-322.
[3]李鹏斌,覃松,喻忠斌.腓骨钩钢板治疗Danis-Weber A/B型踝关节不稳定骨折的疗效分析[J].骨科,2013,4(1):25-27.
[4]Tornetta P 3rd.Competence of the deltoid ligament in bimalleolarankle fractures after medial malleolar fixation[J].J Bone JointSurg Am,2000,82(6):843-848.
[5]Thomas G,Whalley H,Modi C.Early mobilization of operativelyfixed ankle fractures:a systematic review[J].Foot Ankle Int,2009,30(7):666-674.
[6]Soohoo NF,Krenek L,Eagan MJ,et al.Complication rates follow-ing open reduction and internal fixation of ankle fractures[J].JBone Joint Surg Am,2009,91(5):1042-1049.
[7]黄卫民.手术治疗三踝骨折的临床疗效探讨[J].骨科,2012,3(4):209-210.
[8]Tan EW,Sirisreetreerux N,Paez AG,et al.Early weightbearingafter operatively treated ankle fractures:a biomechanical analy-sis[J].Foot Ankle Int,2016,37(6):652-658.
[9]King CM,Cobb M,Collman DR,et al.Bicortical fixation of medialmalleolar fractures:a review of 23 cases at risk for complicatedbone healing[J].J Foot Ankle Surg,2012,51(1):39-44.
[10]赵宏谋,梁晓军,俞光荣,等.三种内固定方法治疗后侧Pilon骨折的临床与生物力学分析[J].中国修复重建外科杂志,2013,27(10):1190-1195.
[11]陈宇,张晖,黄富国,等.外踝钩钢板在Ⅱ度旋后-内收型内踝骨折中的应用[J].中国修复重建外科杂志,2014,28(9):1077-1081.
[12]孙涛,王丹,周智勇,等.外踝解剖型钩状钢板在Weber A型踝部骨折固定中的生物力学分析[J].中国修复重建外科杂志,2008,22(7):824-827.