15 踝上截骨术治疗踝关节骨折畸形做愈合的策略.pdfVIP

踝上截骨术治疗踝关节骨折畸形愈合的策略 谢鸣 方真华 勘武生 黄若坤 胡家朗 郑琼 陈明 华中科技大学附属普爱医院 武汉骨科医院足踝外科 【摘要】 目的 观察踝上截骨术治疗踝关节骨折畸形愈合的 疗效。 方法 我院自2005 年9 月至2008 年10 月，对15 例踝关节 骨折畸形愈合行踝上截骨术治疗，13 例获得完整随访资料： 11 例行 胫骨内侧楔形截骨术即时矫正踝关节内翻，有 3 例在即时矫正内翻的 同时行跗管松解术，2 例因踝关节内翻畸形愈合合并马蹄畸形，在行 胫骨圆形穹顶状截骨同时用 Ilizarov 外固定架下缓慢牵张矫正原始 畸形；11 例同时行腓骨退旋延长术。用美国骨科足踝外科协会AOFAS 踝关节功能评分系统进行评分。 结果 13 例获得 12~48 个月（平 均 27.3 个月）随访，骨折全部愈合，平均临床愈合时间为 14.5 周 （11~17周），完全负重时间平均为 14.1 周（1~19 周）。术后12 个月 踝关节AOFAS 评分为61~95分，平均 86.5 分,其中优8 例，良3 例， 一般2 例，优良率 84.6％。1 例术后出现足内侧皮肤感觉麻木，经行 营养神经对症治疗后无缓解。无内固定失效和伤口愈合不良等其他并 发症。 结论 采用踝上截骨术治疗踝关节骨折畸形愈合，可获得满 意效果。 【关键词】： 踝关节；畸形愈合；手术；截骨术；疗效 Study of the therapeutic effect of supramalleolar osteotomy for malunion on ankle joint Fang Zhen-hua, XIE Ming, KAN Wu-sheng, et al.,Wuhan 430030, China Corresponding author: Fang Zhen-hua, E-mail: bone_ghost@. 【Abstract 】 Objective To investigate the therapeutic effect of supramalleolar osteotomy for malunion of the ankle joint. Methods 15 patients being admitted to our hospital from September, 2005 to octomber,2008, who had suffering from malunions on the ankle jiont, were treated with this operation. 13 patients of them obtained full informations, 11 had got the open wedge-shaped osteotomy and the other 11 of which had treated with the lengthening osteotomy of the fibula. In detail, of the 12 patients, 10 had been corrected the varus deformity of the ankle immediately during the operation, 3 cases also got the releaseing of tarsal tunnel at the same time. Besides this operation, while the other 2 cases which had a severe varus deformity, were also treated with the Ilizarov correct the malformation slowly. The function of the ankles were assemented by the AOFAS scoring