1/3管型防滑鋼板治療三踝骨折中后踝骨折的臨床研究

解品亮　殷勇　李云飛　張秋琴　高生

[摘要] 目的 探討應用1/3管型防滑鋼板治療三踝骨折中后踝骨折的手術方法及臨床療效。 方法 收集2011年9月～2015年1月間我院58例三踝骨折包含后踝骨折患者，其中男26例，女32例。年齡21～72歲，平均46.5歲。對于后踝骨折使用1/3管型防滑鋼板固定48例，單純拉力螺釘固定10例。手術入路采用外踝外側切口，外踝骨折復位固定后，沿跟腱外側前緣切開深筋膜，顯露踇短屈肌，切開部分骨膜或部分踇短屈肌，顯露近端骨折線，然后復位、透視，并放置內固定。術后1周開始無負重功能鍛煉，6周后拐杖或助行器下逐步部分負重，60歲以上患者術后8周開始逐步負重。 結果 所有患者均獲得隨訪，隨訪時間6～18個月，平均13.5個月。隨訪期間，所有患者均獲得Ⅰ期愈合，骨折愈合時間3～4.2個月，平均3.5個月。隨訪期內無術后復位丟失，無創傷性骨關節炎發生。術后采用Olerud-Molander評分標準對踝關節功能評分，鋼板固定組術后6個月平均93.7分，單純拉力螺釘固定組術后6個月平均91分。 結論 對于患者使用1/3管型防滑鋼板治療三踝骨折中后踝骨折具有復位精確、術后并發癥少、實現早期功能鍛煉及負重行走、能有效減少畸形愈合的優點，為三踝骨折中后踝骨折較理想的手術固定方法。

[關鍵詞] 三踝骨折；后踝骨折；關節內骨折；手術；1/3管型防滑鋼板

[中圖分類號] R683.4 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0074-04

[Abstract] Objective To investigate the surgical method and clinical effect of applying one-third tubular non-slip steel plate in the treatment of posterior malleolus fracture of triple-malleolus fracture. Methods 58 patients with ankle fracture including posterior malleolus fracture from September 2011 to January 2015 in our hospital were collected， including 26 males and 32 females. And the patients were aged 21 to 72 years old， with an average of 46.5 years old. For the posterior ankle fracture， there were 48 cases of using one-third tubular non-slip steel plate for fixation and 10 cases of simple pull screw fixation. The lateral malleolus incision was used as surgical approach. After lateral malleolus fracture reduction and fixation， deep fascia was incised along lateral front edge of the achilles tendon， and short flexor was revealed. Part of the periosteum and short thumb flexor was incised. The proximal fracture line or short flexor was revealed， and then reset， perspective was performed. And internal fixation was placed. From one week after operation， no weight-bearing functional exercise was taken. 6 weeks later， gradually partial load was added under crutches or aids. And the patients over 60 years of age started to gradually take load 8 weeks later. Results All patients were followed up for 6-18 months with an average of 13.5 months. During the follow-up period， all patients got the first phase of healing， and the fracture healing time was 3 to 4.2 months， with an average of 3.5 months. No postoperative reduction loss and no invasive osteoarthritis occurred during the follow-up period. The Olerud-Molander grading standard was used to evaluate the ankle joint function after surgery. The average score was 93.7 points in the plate fixation group and 91 points in simple pull screw fixation group at 6 months after surgery. Conclusion The one-third tubular non-slip steel plate in the treatment of posterior malleolus fracture of triple-malleolus fracture has the advantages of accurate reduction， less postoperative complications， early functional exercise and weight-bearing walking， which can effectively reduce malunion， and is an ideal surgical fixation for posterior malleolus fracture of triple-malleolus fracture.

[Key words] Triple-malleolus fracture； Posterior malleolus fracture； Intra-articular fracture； Surgery； One-third tubular non-slip steel plate

踝關節骨折是骨科門急診中的常見病、多發病，發病率約占全身骨折的3.9%，累及后踝骨折占14%～44%[1-3]。后踝骨折是影響踝關節骨折預后的重要因素，后踝的完整性和韌帶附著點對脛距關節負荷轉移、距骨后方穩定性、踝關節旋轉穩定性有著非常重要的作用。……