后踝关节面解剖复位在踝关节骨折手术治疗中的临床意义.doc

后踝关节面解剖复位和内固定在踝关节骨折手术治疗中的临床意义 施保华 沈决心 谭晚明 上海市崇明县堡镇人民医院骨科 202157 【摘要】目的 总结治疗踝关节骨折中后踝骨折的手术方法和治疗效果。方法 自2005年3月-2010年6月，手术治疗后踝骨折54 例。男36例，女18例；根据CT分类Ⅰ型36例，Ⅱ型10例，Ⅲ型8例。应用改良的Baird-Jackson评分系统对其术后疗效进行评定，并将骨折类型、骨折固定方法、术后功能锻炼时间与最终功能的关系进行分析。结果 随访时间为6-36个月，平均18个月。54例疗效为：优29 例，良18 例，可5例，差2例，优良率为87.03%。除4 例长时间行走有轻微疼痛外，其余患者均无疼痛。结论 手术治疗后踝骨折可取得满意的骨折复位和临床疗效，复位的质量与疗效密切相关，判断骨折类型和选择固定方法对于提高复位质量，改善远期疗效十分重要。 【关键词】后踝骨折；解剖复位；内固定；踝关节骨折手术治疗 The clinical significance of anatomic reduction and internal fixation of posterior malleolar fracture in ankle fracture surgical treatment SHI Baohua SHEN Juexin Department of Orthopedics, The People’s Hospital of BaoZhen; ChongMing ; ShangHai ; 202157 Abstract Objective To evaluate the clinical significance of anatomic reduction and internal fixation of posterior malleolar fracture in ankle fracture surgical treatment Methods Fifty-four patients with posterior malleolar fracture were treated with anatomic reduction and internal fixation from March 2005 to June 2010. The patients groups consisted of 36 males and 18 females. According to CT scan classification, the group was made up of 36 typeⅠ cases, 10 typeⅡ and 8 typeⅢ cases. All patients were evaluated with modified Baird-Jackson scoring system. The relationship between final result and fracture pattern , fixation methods, the time of exercise initiation fitted operation were analyzed respectively. Results The followed-up period varied from 6 months to 36 months, with an average of 18 months. The number of patients whose result was excellent, good, fair and poor was respective 29,18,5 and 2. The total percent age of good to excellent clinical result was 87.03%. There were 4 patients who had only slight pain after long time walking , the remainder patients were completed with no pain. Conclusion Operative treatment may provide satisfactory fracture anatomic reduction and internal fixation for posterior malleolar fracture. Correct fracture pattern estimation and proper internal fixation were of i