踝关节骨折的治进展.doc

踝关节骨折的治疗进展 王国利 李成才 摘要：踝关节骨折临床上较常见，包括单踝骨折，双踝骨折，三踝骨折和腓骨骨折。骨折分型包括Ashhurs分型、Danis-Weber分型以及在此基础上提出的AO分型、Lauge-Hansen分型。踝关节骨折应强调解剖复位、坚强固定。可采取非手术治疗和手术治疗。手术治疗的重点应恢复踝穴正常解剖关系。应先固定腓骨，后固定后踝和内踝，最后固定下胫腓。手术时机可以在伤后6—8h，也可延至伤后3-14d。腓骨远端骨折的固定可选用单枚螺钉、克氏针张力带、外侧中和（保护）钢板或后侧抗滑钢板。内踝、后踝的内固定建议使用克氏钟张力带，螺钉、空心钉或可吸收螺钉。下胫腓的功能是防止距骨过度外旋、外展，对维持踝关节的功能极为重要。下胫腓联合损伤是否固定应术中根据Cotton试验判断下胫腓联合的稳定性来决定。固定方法包括螺钉固定、胫腓钩固定、钩板、钢丝捆扎带以及韧带重建等。 关键词：踝关节骨折；分型；内固定；下胫腓联合 Abstract: The ankle fractures clinical less common, including single ankle fractures, double ankle fractures, three ankle fractures and fibula fractures. Fracture classification including Ashhurs , Danis-Weber and AO based on Danis-Weber, Lauge-Hansen . Ankle fractures should emphasize anatomical reattachment, strong fixed. Can take nonoperative treatment and surgery. The surgical treatment of key should be restored ankle acupuncture point the normal anatomy. Operation should be fixed first fibula and posterior malleolar and medial malleolar , finally fixed The lower tibiofibular ligament union. The operation time can hurt in 6-8 h, also can be extended to 3 to 14 d after injury. Fibular end fractures fixed can choose single pieces screw, Kirschner tension band, and lateral neutralization (protection) steel plate or Sliding resistance back plate. medial malleolar and posterior malleolar, fixation suggest using Kirschner tension band, screw, cannulated screws or can absorb the screws. The function of the lower tibiofibular ligament union is to prevent the talus excessive spin and outreach, to maintain the function of the ankle is very important. The lower tibiofibular ligament union damage whether fixed should intraoperative according to Cotton test judgment the stability of the lower tibiofibular ligament union will decide. Fixed methods including screws, tibial phil hooks, hook board, steel wire strapping belt and ligament reconstruction, etc. Keywords: ankle fractures; classification; Internal fixation; The lower tibiofibular ligam