特殊踝关节骨折-单纯后踝骨折的治疗策略
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摘要
[目的]探讨特殊的单纯后踝骨折的临床特点和治疗策略。[方法] 2010年1月～2014年12月,治疗单纯后踝骨折共32例,伤后行踝关节查体及踝关节放射影像、CT及MR检查评价韧带损伤情况及通过CT测量后踝骨块面积比值。对于不稳定单纯后踝骨折,应用带线锚钉系统解剖修复韧带损伤,同时固定后踝骨块。[结果]所有病例至少随访2年,术后1年及2年应用美国足踝外科医师协会踝-后足评分系统(AOFAS)、Olerud和Molander踝关节骨折评分系统(OMAS)评价踝关节功能,差异无统计学意义。术后无韧带松弛不稳及内固定失效松动断裂。所有患者对术后踝关节稳定及功能有较高满意度。[结论]手术固定骨块的同时修复韧带损伤治疗不稳定单纯后踝骨折可获得良好的临床疗效。
[Objective] To evaluate the clinical characters and strategy of isolated posterior malleolar fracture. [Methods]Between January 2010 and December 2014, 32 patients with isolated posterior malleolar fracture were surgically treated. Following physical examination, the ankle radiographs, CT scans and MRI were taken to make sure which structures were affected,meanwhile fragment area ratio was measured with morphologic assessments in the CT scans preoperatively. For unstable isolated posterior malleolar fracture, anatomical repair of the ligament with anchor suture and fracture fixation with cannulated screw or mini plate were simultaneously performed. [Result] All patients were followed up at least 2 years. There was no significant difference regarding to AOFAS score and OMAS score between those at 1 year and 2 years postoperatively. No ligament instability and implant breakage or loosening were noted in anyone of them. All patients were satisfied with their improvement in stability and ankle function. [Conclusion] The unstable isolated posterior malleolar fracture should be concurrently treated the fracture fragment and ligament tear to achieve good clinical and functional outcomes.
[Objective] To evaluate the clinical characters and strategy of isolated posterior malleolar fracture. [Methods]Between January 2010 and December 2014, 32 patients with isolated posterior malleolar fracture were surgically treated. Following physical examination, the ankle radiographs, CT scans and MRI were taken to make sure which structures were affected,meanwhile fragment area ratio was measured with morphologic assessments in the CT scans preoperatively. For unstable isolated posterior malleolar fracture, anatomical repair of the ligament with anchor suture and fracture fixation with cannulated screw or mini plate were simultaneously performed. [Result] All patients were followed up at least 2 years. There was no significant difference regarding to AOFAS score and OMAS score between those at 1 year and 2 years postoperatively. No ligament instability and implant breakage or loosening were noted in anyone of them. All patients were satisfied with their improvement in stability and ankle function. [Conclusion] The unstable isolated posterior malleolar fracture should be concurrently treated the fracture fragment and ligament tear to achieve good clinical and functional outcomes.
引文
[1] Bartonicek J, Rammelt S, Kostlivy K, et al. Anatomy and classification of the posterior tibial fragment in ankle fractures[J]. Arch Orthop Trauma Surg, 2015, 135(4):505-516.
[2]文哲,郑晓明,程义权.后踝骨折的生物力学分类与治疗[J].中国矫形外科杂志, 2000, 8(12):31-33.
[3] Serbest S, Tiftikci U, Tosun H B, et al. Isolated posterior malleolus fracture:a rare injury mechanism[J]. Pan Afr Med J, 2015, 20(1):123.
[4] Comat G, Barbier O, Ollat D. The posterior malleolar fracture:a parachute injury not to be overlooked[J]. Orthop Traumatol Surg Res, 2014, 100(4):419-422.
[5] Nugent JF, Gale BD. Isolated posterior malleolar ankle fractures[J]. J Foot Surg, 1990, 29(1):80-83.
[6] Ozler T, Guven M, Onal A, et al. Missed isolated posterior malleolar fractures[J]. Acta Orthop Traumatol Turc, 2014, 48(3):249-252.
[7] Tartaglione JP, Rosenbaum AJ, Abousayed M, et al. Classifications in brief:lauge-hansen classification of ankle fractures[J]. Clin Orthop, 2015, 473(10):3323-3328.
[8] Smeeing DPJ, Houwert RM, Kruyt MC, et al. The isolated posterior malleolar fracture and syndesmotic instability:A case report and review of the literature[J]. Int J Surg Case Rep, 2017, 41:360-365.
[9] Donken CC, Goorden AJ, Verhofstad MH, et al. The outcome at 20years of conservatively treated'isolated'posterior malleolar fractures of the ankle:a case series[J]. J Bone Joint Surg Br, 2011, 93(12):1621-1625.
[10] Yao L, Zhang W, Yang G, et al. Morphologic characteristics of the posterior malleolus fragment:a 3-D computer tomography based study[J]. Arch Orthop Trauma Surg, 2014, 134(3):389-394.
[11] Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle[J]. J Bone Joint Surg Am, 2006,88(5):1085-1092.
[12] Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures[J]. Int Orthop, 2012, 36(9):1929-1936.
[13] Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin[J]. J Trauma, 2002, 53(1):55-60.
[14] Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability[J]. Clin Orthop, 2006, 447(447):165-171.
[15] Irwin TA, Lien J, Kadakia AR. Posterior malleolus fracture[J]. J Am Acad Orthop Surg, 2013, 21(1):32-40.
[16] Gardner MJ, Streubel PN, Mccormick JJ, et al. Surgeon practices regarding operative treatment of posterior malleolus fractures[J].Foot Ankle Int, 2011, 32(4):385-393.
[17]庄颖峰,张旭鸣,许玮,等.后踝骨折的损伤机制及手术治疗结果分析[J].中国矫形外科杂志, 2017, 25(10):954-958.
[18] Boggs LR. Isolated posterior malleolar fractures[J]. Am J Emerg Med, 1986, 4(4):334-336.
[2]文哲,郑晓明,程义权.后踝骨折的生物力学分类与治疗[J].中国矫形外科杂志, 2000, 8(12):31-33.
[3] Serbest S, Tiftikci U, Tosun H B, et al. Isolated posterior malleolus fracture:a rare injury mechanism[J]. Pan Afr Med J, 2015, 20(1):123.
[4] Comat G, Barbier O, Ollat D. The posterior malleolar fracture:a parachute injury not to be overlooked[J]. Orthop Traumatol Surg Res, 2014, 100(4):419-422.
[5] Nugent JF, Gale BD. Isolated posterior malleolar ankle fractures[J]. J Foot Surg, 1990, 29(1):80-83.
[6] Ozler T, Guven M, Onal A, et al. Missed isolated posterior malleolar fractures[J]. Acta Orthop Traumatol Turc, 2014, 48(3):249-252.
[7] Tartaglione JP, Rosenbaum AJ, Abousayed M, et al. Classifications in brief:lauge-hansen classification of ankle fractures[J]. Clin Orthop, 2015, 473(10):3323-3328.
[8] Smeeing DPJ, Houwert RM, Kruyt MC, et al. The isolated posterior malleolar fracture and syndesmotic instability:A case report and review of the literature[J]. Int J Surg Case Rep, 2017, 41:360-365.
[9] Donken CC, Goorden AJ, Verhofstad MH, et al. The outcome at 20years of conservatively treated'isolated'posterior malleolar fractures of the ankle:a case series[J]. J Bone Joint Surg Br, 2011, 93(12):1621-1625.
[10] Yao L, Zhang W, Yang G, et al. Morphologic characteristics of the posterior malleolus fragment:a 3-D computer tomography based study[J]. Arch Orthop Trauma Surg, 2014, 134(3):389-394.
[11] Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle[J]. J Bone Joint Surg Am, 2006,88(5):1085-1092.
[12] Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures[J]. Int Orthop, 2012, 36(9):1929-1936.
[13] Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin[J]. J Trauma, 2002, 53(1):55-60.
[14] Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability[J]. Clin Orthop, 2006, 447(447):165-171.
[15] Irwin TA, Lien J, Kadakia AR. Posterior malleolus fracture[J]. J Am Acad Orthop Surg, 2013, 21(1):32-40.
[16] Gardner MJ, Streubel PN, Mccormick JJ, et al. Surgeon practices regarding operative treatment of posterior malleolus fractures[J].Foot Ankle Int, 2011, 32(4):385-393.
[17]庄颖峰,张旭鸣,许玮,等.后踝骨折的损伤机制及手术治疗结果分析[J].中国矫形外科杂志, 2017, 25(10):954-958.
[18] Boggs LR. Isolated posterior malleolar fractures[J]. Am J Emerg Med, 1986, 4(4):334-336.