中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (26): 4907-4910.doi: 10.3969/j.issn.1673-8225.2010.26.039

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

老年踝关节旋后外旋型骨折金属植入物内固定方式及内固定物选择

李  军，柴卫兵，卢宏章，刘震宁，刘宪义，朱天岳   

  1. 北京大学第一医院骨科，北京市  100034
  • 出版日期:2010-06-25 发布日期:2010-06-25
  • 作者简介:李 军，男，1972年生，湖北省武汉市人，汉族，2001年北京大学医学部毕业，博士，副主任医师，主要从事关节与创伤的研究。 lijunsurgeon@ medmail.com.cn

Internal fixation modes and materials of metal implants for displaced supination-eversion ankle fractures in elderly patients

Li Jun, Chai Wei-bing, Lu Hong-zhang, Liu Zhen-ning, Liu Xian-yi, Zhu Tian-yue   

  1. Department of Orthopaedics, Peking University First Hospital, Beijing  100034, China
  • Online:2010-06-25 Published:2010-06-25
  • About author:Li Jun, Doctor, Associate chief physician, Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China lijunsurgeon@medmail.com.cn

PDF

593

被引次数

18

摘要：

背景：为了恢复关节的功能，移位的旋后外旋型踝关节骨折常常需要切开复位内固定。老年人由于存在骨质疏松，实施内固定存在一定困难，而且容易出现伤口并发症。

目的：探讨老年移位的踝关节旋后外旋骨折手术治疗方式及内固定物的选择。

方法：选择北京大学第一医院骨科收治的移位踝关节旋后外旋型骨折患者128例，其中单纯外踝骨折29例，双踝骨折52例，三踝骨折47例。外踝选用前外侧切口98例，后外侧切口30例；后侧防滑接骨板固定6例，加压螺钉与中和接骨板固定122例(其中1/3管状接骨板98例，锁定接骨板24例)；内踝骨折均使用空心加压螺钉固定；后踝骨折通过后外侧切口复位固定24例。术后根据骨折稳定情况，选择是否使用石膏外固定。随访时，根据X射线平片评估骨折愈合情况，采用Olerud and Molander评分系统进行评定。

结果与结论：128例患者均获得随访，随访时间12~25个月，骨折均愈合。外踝伤口延迟愈合5例(4%)，其中锁定接骨板固定者3例、1/3管状板2例，两者间差异无显著性意义(P > 0.05)。无深部感染发生。骨折愈合后关节功能评分优55例，良61例，可10例，差2例，优良率91%。骨折愈合后，因局部不适取出内固定物31例，其中管状接骨板19例，锁定接骨板12例，两者相比，差异有显著性意义(P < 0.05)。在取出的12例锁定接骨板中，2例(17%)发生螺钉与接骨板间的“冷焊接”。1例防滑接骨板固定后出现腓骨肌腱炎，保守治疗后疼痛缓解。提示针对老年人移位的踝关节旋后外旋型骨折，合理选用手术入路和内固定物有利于减少伤口的并发症，解剖复位和良好的内固定有利于骨折恢复。

关键词: 踝关节, 骨折, 内固定, 并发症, 植入物

Abstract:

BACKGROUND: Stable anatomical reconstruction of the joint surface in displaced supination-eversion ankle fractures is essential to successful recovery. It is difficult to fix the osteoporosis ankle fracture in the elderly patients, thus, complications often happen after open reduction and internal fixation.

OBJECTIVE: To explore the surgical treatment internal fixation selection for displaced supination-eversion ankle fracture in elderly patients. 

METHODS: Totally 128 elderly patients with supination-eversion ankle fractures were treated by open reduction and internal fixation. Twenty-nine cases had only lateral malleolus fracture, 52 had bimalleolar fracture and 47 had trimalleolar fracture. A total of 122 patients were treated with a conventional lateral plate (98 one-third tubular plates and 24 locking-plates), and six patients were treated with an antiglide plate. Posterior malleolus fractures with defects bigger than 1/4 of the joint surface were reduced and fixed with compression screw of 3.5 mm through posterolateral approach. Their functional results were evaluated according to the Olerud and Molander system and the bone healing was evaluated by X-ray film. 

RESULTS AND CONCLUSION: All patients were followed-up for 12-25 months. The fractures were healed in all cases. Five cases (4%) suffered from delayed wound union, including three patients treated with locking plates and two patients with one-third tubular plates. The clinical results were satisfactory, with the excellent and good ratio of ankle score being 91%. Thirty-one patients treated with lateral plates underwent implants removal after union, including 19 cases with tubular plates and 12 cases with locking plates, there was significant difference (P < 0.05). Cold-welding occurred in two cases (17%) treated with locking plates during the removal of implants. One case suffered from peroneal tendonitis after antiglide plate fixation. Exact reduction, stable internal fixation and active postoperative rehabilitation can help the joint recover to normal function in elderly patients with displaced supination-eversion ankle fractures.

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