Mont M A, Sedlin E D, Weiner L S, Miller A R
Department of Orthopaedic Surgery, Mount Sinai Services, Elmhurst Hospital Center, New York.
J Orthop Trauma. 1992;6(3):352-7. doi: 10.1097/00005131-199209000-00014.
This study reviews a group of 80 consecutive displaced ankle fractures treated operatively and followed for an average of 3.2 years. Fractures included bone or combined bone and ligamentous injuries in which the initial talar displacement was greater than or equal to 2 mm. The immediate postoperative roentgenograms were examined for several features, which included widening of the syndesmosis, fibular length, talo-crural angle, talar tilt, presence and size of a posterior malleolar fracture, and an abnormality of the medial clear space. Patients were examined at follow-up per Cedell, and their clinical evaluations were correlated with the analysis of radiographic features and demographic data. Good to excellent results were seen in 80% of the cases. The radiographic factors most predictive of a poor outcome were abnormal medial clear space and the presence of a large (greater than 20%) posterior malleolar fracture (p less than 0.05). Fibular shortening, talar tilt, and syndesmotic widening suggested a poor result, but these findings were not statistically significant. Multiple (two or more) radiographic abnormalities correlated with a poor prognosis. Conversely, a perfect radiographic result did not guarantee an excellent clinical outcome. Older patients and those with a delay between injury and surgery greater than 7 days tended to have a poorer result.
本研究回顾了一组连续80例接受手术治疗的踝关节移位骨折患者，平均随访3.2年。骨折包括骨损伤或合并骨与韧带损伤，其中初始距骨移位大于或等于2毫米。对术后即刻的X线片检查了几个特征，包括下胫腓联合增宽、腓骨长度、胫距角、距骨倾斜、后踝骨折的存在及大小以及内侧间隙异常。按照Cedell方法在随访时对患者进行检查，并将其临床评估结果与影像学特征分析及人口统计学数据相关联。80%的病例结果为良好至优秀。对预后不良最具预测性的影像学因素是内侧间隙异常和存在较大（大于20%）的后踝骨折（P<0.05）。腓骨短缩、距骨倾斜和下胫腓联合增宽提示预后不良，但这些发现无统计学意义。多种（两种或更多）影像学异常与预后不良相关。相反，完美的影像学结果并不能保证优异的临床结局。年龄较大的患者以及受伤与手术间隔时间超过7天的患者往往预后较差。
