摘要
目的:探讨Lauge-HansenⅣ度踝关节骨折关节镜辅助下手术治疗的临床效结果。方法:自2008年1月至2009年12月,对42例踝关节骨折采用关节镜辅助下切开复位内固定治疗。骨折按Lauge-Hansen分类法:旋后外旋型Ⅳ度26例,女11例,男15例,平均年龄(36.8±11.7)岁;旋前外旋型Ⅳ度16例,女6例,男10例,平均年龄(37.6±11.2)岁。所有患者在关节镜辅助下行骨折切开复位内固定,镜下观察韧带及软骨损伤情况,下胫腓联合分离患者行下胫腓联合螺钉固定,软骨损伤按Cheng-Ferkel分期进行治疗。临床疗效采用AOFAS评分系统进行评价。结果:42例均获随访,时间1年。术后AOFAS评分为(92.00±9.32)分,临床疗效优28例,良11例,可3例,其中31例存在不同程度的软骨损伤。无软骨损伤患者的AOFAS评分高于软骨损伤患者,C级以下软骨损伤患者的AOFAS评分高于C级以上软骨损伤患者,无软骨损伤患者的AOFAS评分高于C级以上软骨损伤患者。下胫腓联合固定患者AOFAS评分低于未固定组患者。结论:Lauge-HansenⅣ度踝关节骨折常合并有关节内软骨及周围韧带损伤,其中下胫腓联合损伤及C级以上的软骨损伤是导致踝关节功能恢复欠佳的重要因素,关节镜辅助下切开复位内固定治疗不仅利于关节面的解剖复位,同时可以对合并的软骨和韧带损伤进行更好的诊治,从而提高手术的临床效果。
Objective：To explore the clinical results of arthroscopy-assisted open reduction and internal fixation for the treatment of acute Lauge-Hansen stageⅣankle fractures. Methods：A prospective cohort of study was done in 42 patients of acute ankle fractures treated with arthroscopy-assisted open reduction and internal fixation from January 2008 to December 2009. According to Lauge-Hansen classification,there were 26 supination-eversion stageⅣfractures,including 11 females and 15 males;with an average age of （36.8±11.7） years;and there were 16 pronation-eversion stageⅣfractures,including 6 females and 10 males,with an average age of（37.6±11.2）years. All the patients were treated with arthroscopy-assisted open reduction and internal fixation,and intra-articular disorders were observed. Syndesmotic diastasis was treated with three-cortices syndesmotic screw,and osteochondral injuries were disposed by Cheng-Ferkel staging system. The clinical effects were evaluated according to AOFAS scores. Results：All the patients were followed up for 1 year. At the final review,the mean AOFAS score was （92.00±9.32）. Twenty-eight patients got an excellent result,11 good,3 fair. Lesions of the cartilage were found in 31 cases. The AOFAS scores of patients with osteochondral lesions were higher than those of patients without osteochondral lesions. The AOFAS scores of patients with osteochondral lesions below C grade were higher than those of patients with osteochondral lesions above C grade. The AOFAS scores of patients with osteochondral lesions were higher than those of patients with osteochondral lesions above C grade. The AOFAS scores of patients with syndesmosis fixation were lower than those of patients without syndesmosis fixation. Conclusion：Intra-articular disorders are common in Lauge-Hansen stage Ⅳankle fractures,and osteochondral lesion and sydesmosis diastasis are the most important prognostic factor that leads to unsatisfactory ankle functions. Arthroscopy-assisted open reduction and internal fixation for the treatment of acute ankle fractures is not only helpful to anatomical reduction of the articular surface,but also can improve the clinical results with effective diagnosis and treatment of combined intra-articular disorders.
出处
《中国骨伤》
CAS
2011年第9期714-718,共5页
China Journal of Orthopaedics and Traumatology
基金
浙江省医药卫生科技计划项目(编号:2010KYA04)~~
关键词
踝
骨折
软骨
关节镜
Ankle
Fractures
Cartilage
Arthroscopy
