手术治疗踝关节旋后―外旋Ⅳ度损伤的临床分析.DOCVIP

临床医学论文-手术治疗踝关节旋后―外旋Ⅳ度损伤的临床分析 ???????????? 作者：施继飞 黄建明 李顺利 【摘要】? 目的? 回顾分析手术复位螺钉内固定治疗踝关节旋后―外旋Ⅳ度损伤的治疗疗效。方法? 自1998年5月～2003年3月，共手术治疗37例踝关节旋后―外旋Ⅳ度损伤，获随访33例，随访时间12～40个月，平均18个月，男21例，女12例；年龄17～68岁，平均38岁。左侧18例，右侧15例，均为单侧。其中内踝骨折31例，行拉力螺钉内固定，2例无内踝骨折为单纯三角韧带撕裂，作韧带修补。后踝骨折27例，其中17例作拉力螺钉内固定，10例因骨折块移位＜1mm未作复位固定，6例无后踝骨折。33例外踝骨折，用2枚皮质骨螺钉过骨折线固定。共有4例行下胫腓联合固定，用1枚拉力螺钉过3层皮质固定。所有病例术后石膏托辅助固定4～6周。结果 用Mazur踝关节症状与功能评分系统评判，优23例，良7例，可3例，无差。优良率91%。结论? 手术复位螺钉内固定治疗踝关节旋后―外旋Ⅳ度损伤具有优良疗效。 　　【关键词】? 踝关节；骨折；内固定　　　Analysis on results of operation for stage Ⅳ supination-external rotation ankle injury 　　【Abstract】? Objective? To analyse the result of operated for stage Ⅳ supination-external rotation ankle injury.Methods? Thirty-seven cases of stage Ⅳ supination-external rotation ankle injury were operation from May 1998 to Mar 2003.33 cases were followed-up for a period of average of 18 months from 12 months to 40 months.There were 21 males and 12 females.18 cases were of left and 15 of right.31 cases of malleolus fractures were operated by screw fixation,2 cases of simple triangle ligament lacerations without medial malleolus fractures were operated by ligament reparation.27 cases of posterior malleolus fractures,among them,17 cases were fixed with screw,10 cases of fracture displacement less than 1mm were not reduced and fixed.6 cases without posterior malleolus fractures.33 cases of lateral malleolus fractures were fixed with two screws through fracture line.Among 33 cases,4 cases of the distal tibiofibular syndesmosis were fixed with one screw through three layers of bone cortexes.All cases were auxiliary fixed with plaster pad for 4～6 weeks after operation.Results? The symptom and functional evaluation of the ankle joint(Mazur) were scored.Clinical results demonstrated 23 cases excellent,7 cases good,3 cases fair,no poor.An overall excellent and good rate in 91% of the cases was obtained.Conclusion? The operative reduction and screw fixation of operation for stage Ⅳ supination-external rotation ankle inj