摘要
目的研究陈旧性踝关节骨折脱位中合并的内踝骨折、后踝骨折及下胫腓联合损伤对临床预后的影响,指导临床治疗。方法回顾性分析陈旧踝关节骨折脱位且有完整随访者52例,其中47例接受重建的切开复位内固定手术,5例接受保守治疗。根据有无内踝骨折、有无后踝骨折、有无下胫腓联合损伤进行分组,分别分为有内踝骨折组、无内踝骨折组;有后踝骨折组、无后踝骨折组;有下胫腓损伤组,无下胫腓损伤组。全部病例采用美国足踝外科协会踝与后足评分系统（AOFAS评分系统）评估疗效（术后1年）,分别进行AOFAS评分的统计分析,探讨内踝骨折、后踝骨折和下胫腓联合损伤三个因素对临床预后的影响。结果全部骨折平均随访35.6个月（13~60个月）。47例采用切开复位内固定治疗的患者骨折均愈合,未出现再次脱位。其中内外踝切口皮缘坏死共4例,对症处理后均愈合。有内踝骨折组AOFAS评分77.5±10.7分,无内踝骨折组AOFAS评分82.1±8.3分,两组无统计学差异（P〉0.05）。有后踝骨折组AOFAS评分75.4±12.7分,无后踝骨折组AOFAS评分82.1±6.1分,两组有统计学差异（P〈0.05）。有下胫腓联合损伤组AOFAS评分77.8±10.6分,无下胫腓联合损伤组AOFAS评分82.2±8.2分,两组无统计学差异（P〉0.05）。结论合并内踝骨折、下胫腓联合损伤与否对预后的影响没有统计学差异;合并的后踝骨折影响患者的功能愈后。
Objective To study the effect factors of the clinical outcome of old ankle fractures and dislocation and guide the clinical treatment. Methods 52 cases of old ankle fractures and dislocation in our hospital between August2003 and July 2014 were analyzed,The American Orthopaedic Foot and Ankle Society（ AOFAS） rating system was used to evaluate the function of the ankle postoperatively（ 1 year post-operation）. All cases were divided into two groups according to three fractors： posterior malleolar fractures,medial malleolar fractures,the integrity of distal tibiofibular syndesmosis,in order to find out whether they have any influence on the final results. Results The mean follow-up time was 35. 6months（ range 13 ~ 60 months）. All cases were reported good from the revision procedure. 4 cases of skin flay necrosis recovered well after proper treatment. There was a significant difference（ P 0. 05） with the condition that whether the patients associated with posterior malleolar fractures or not. But there was no significant difference whether the patients had medial malleolar fractures or not. Distal tibiofibular syndesmosis injury also has no influence on the final results. Conclusion For old ankle fractures,posterior malleolar fractures will affect clinical outcome. Medial malleolar fractures and distal tibiofibular syndesmosis injury has no influence on the final results.
出处
《中南医学科学杂志》
CAS
2015年第5期549-553,共5页
Medical Science Journal of Central South China
关键词
陈旧性踝关节骨折
脱位
治疗
临床预后
影响因素
old ankle fracture
dislocation
treatment
clinical outcome
affect factor
