135例踝关节骨折手术的回顾分析

徐健　张亮

[摘要] 目的 探讨踝关节骨折手术的疗效与注意事项。 方法 对整群选取的2008年3月—2014年1月期间，该院采用切复位内固定治疗踝关节骨折135例病例进行回顾性分析。其中根据AO（ASIF）分型，A型46例，B型37例，C型53例，闭合性骨折114例，开放性骨折21例，均采用切开复位内固定治疗。结果 116例术后切口I期愈合，10例出现内植物排异反应，9例出现术后感染。患者均获随访1-24个月，平均11个月，远期随访骨折均愈合。临床疗效按Baird-Jackson踝关节评分系统评定，优111例，良18例，可5例，差1例，优良率95.5%。骨折愈合时间10～19周，平均（13.8±1.4）周。 结论 根据踝关节骨折类型、严重程度选择相应合理的手术方式及手术时机可获得满意的临床疗效。

[关键词] 踝关节；骨折；手术

[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-0742（2015）09（c）-0070-02

[Abstract] Objective To discuss the efficacy and points for attention of ankle fracture operation. Methods 135 patients with ankle fracture undergoing open reduction and internal fixation between March 2008 and January 2014 were retrospectively analyzed. According to the AO （ASIF） classification， there were 46 cases of type A fractures， 37 type B fractures， and 53 type C fractures， and there were 114 closed fractures and 21 open fractures. All the patients were treated with open reduction and internal fixation. Results 116 patients obtained primary healing on incisions， while transplantation rejection was noted in 10 patients and postoperative infection in 9 patients. All the patients were followed up for 1～24 months with an average of 11 months. All fractures healed at long-term follow-up. According to Baird-Jackson ankle joint scoring system， the efficacy of 111 patients were excellent， 18 were good， 5 were quite good， and 1 was poor， and the excellent and good rate was 95.5%.The fracture healing time was 10～19 weeks with an average of 13.8±1.4 weeks. Conclusion According to the type， severity of ankle joint fracture， we can obtain satisfactory clinical efficacy on the basis of corresponding and reasonable surgical style and proper operation timing.

[Key words] Ankle； Fracture； Operation

踝关节是人体负重最大的关节。踝关节的稳定性与灵活性十分重要，当发生骨折、脱位或韧带损伤时，如果治疗不符合该关节功能解剖特点，会对关节功能造成严重影响[1]。整群选取该院2008年3月—2014年1月期间，采用切口复位内固定治疗踝关节骨折135例病例进行回顾性分析，现报道如下。

1 资料与方法

1.1 一般资料

回顾性该院2008年3月—2014年1月期间135例踝关节骨折病人，年龄17-83岁，平均38.4岁；男性61例，女74例；其中：扭伤62例，砸伤21例，高处坠落伤20例，车祸伤25例；根据AO（ASIF）分型，A型46例，B型37例，C型53例，闭合性骨折114例，开放性骨折21例。

1.2 手术方法

①手术外踝采用标准腓骨远端外侧切口。浅层切开时应小心避免误伤小隐静脉及腓肠神经；骨折端暴露尽量骨膜下分离，避免腓动脉损伤；……