手术治疗旋后外旋型Ⅳ°踝关节骨折的临床疗效评价Clinical evaluation of surgical treatment of supination Ⅳ Ⅳ ankle fracture.pdfVIP

提 要 目的：探讨分析旋后外旋型踝关节骨折的手术治疗方法，提高踝关节骨折的治愈 率。 方法：本研究病例来自山东中医药大学附属医院骨科病房自2008年5月至 2010 年6月收治的47例旋后外旋型Ⅳ°踝关节骨折患者。年龄20～76岁，平均45.21± 1.48岁，其中男28例，女19例，其中车祸伤占23 例，下楼或行走时滑扭伤 13 例， 高处坠落伤 9 例，重物砸伤 2 例。闭合性骨折 39 例。术前进行临床及影像学评估， 确定手术的时机；进行手术治疗，术中应注意切口的选择，软组织的保护，固定方式 的选择；术后指导患者进行系统的功能康复训练，降低并发创伤性关节炎的发生率。 术后随访，随访时间最长为 2 年，最短为半年，采用美国足踝外科协会的 AOFAS 踝― 后足评分系统（The Ankle-hindfoot Sorce ）进行评价，观察疗效。 结果：47例患者，优28例，良12例，一般6例，差1例，优良率为85.1%。 结论：对于旋后外旋型Ⅳ°踝关节骨折应早期手术治疗，尽可能使骨折解剖复位 以及坚强内固定，术前要充分评估骨折和合并损伤情况，选择合理的手术和固定方式； 合并损伤的处理和骨折的处理同样重要；术后早期功能训练对关节功能恢复，降低并 发创伤性关节炎的发生率。 关键词 骨折；踝关节；旋后外旋型；手术治疗 Surgical treatment of supination external rotation ankle fractures Ⅳ ° Clinical Evaluation Speciality: Orthopaedics of TCM Author: Wang PengJu Tutor: Prof Qi ShangFeng Abstract Objective: Analysis of supination external rotation ankle fractures methods to improve the cure rate of ankle fractures Methods: The cases are from Shandong Medical University Hospital orthopedic ward from May 2008 to June 2010 47 cases were treated supination external rotation ankle fractures in patients Ⅳ °. Aged 20 to 76 years, mean 45.21 ± 1.48 years old, 28 males and 19 females, which accounted for 23 cases of traffic accident injuries, slip down the stairs or walking sprain in 13 cases, 9 cases of injury falling from height, weight 2 injured cases. Closed fractures in 39 patients. Preoperative clinical and radiological assessment to determine the timing of surgery; for surgical treatment, surgery should be noted that the choice of incision, soft tissue protection, the choice of a fixed way; after the guidance system in patients with functional rehabilitation training, to reduce concurrent traumatic T