Xu Ye-qing, Zhan Bei-lei, He Fei-xiong, Wei Hong-da
Department of Orthopaedics, the People's Hospital of Quzhou, Quzhou 324000, Zhejiang, China.
Zhongguo Gu Shang. 2008 Apr;21(4):300-1.
To explore the operative method and its clinical effects of pronation and supination external rotation trimalleolar fractures.
From March 2000 to July 2006,42 patients of the pronation and supination external rotation trimalleolar fractures treated with open reduction and internal fixation. Thirty-one were males and 11 were females,with an average age of 40.5 years (from 19 to 76 years). Four cases were open fractures and 38 cases close fractures. The fractures were classified as pronation-external rotation (grade IV) injury in 18 cases and supination-external rotation (grade IV)in 24 cases according to the system of Lauge-Hansen. The time of injury to operation was 2 hours to 27 days. The medial, lateral and posterior malleolus were exposed by standard anteromedial and Gatellier-Chastang approaches. The reduction and internal fixation started with the posterior,then the medial and the lateral malleolus and distal tibiofibular syndesmosis in sequence. The anteroposterior, lateral and mostise X-ray films were taken after operation.
All the patients were followed up for an average time of 13.5 months(from 6 to 24 months). The time of union was from 12 to 16 weeks. The results were excellent in 20,good in 16, fair in 4 and poor in 2 cases according to Baird-Jackson ankle scoring system based on pain, stability, walking ability,range of motion and radiological manifestations. The excellent and good rate was 85.7%. There were no infection,malunion and nonunion of the fractures except that the inserted screw to distal tibiofibular syndesmosis was broken in 1 case.
The key of operative treatment is to restore the anatomy of ankle and to regain the ankle function maximally.
探讨旋前外旋型三踝骨折的手术方法及临床疗效。
2000年3月至2006年7月，对42例旋前外旋型三踝骨折患者行切开复位内固定治疗。男31例，女11例，平均年龄40.5岁（19～76岁）。开放性骨折4例，闭合性骨折38例。根据Lauge-Hansen分型系统，旋前外旋型（Ⅳ度）损伤18例，旋后外旋型（Ⅳ度）损伤24例。受伤至手术时间为2小时至27天。采用标准的前内侧及Gatellier-Chastang入路显露内、外、后踝。按先后顺序复位并固定后踝、内踝、外踝及下胫腓联合。术后摄踝关节正侧位及斜位X线片。
所有患者平均随访13.5个月（6～24个月）。骨折愈合时间为12～16周。根据Baird-Jackson踝关节评分系统，基于疼痛、稳定性、行走能力、活动范围及影像学表现，优20例，良16例，可4例，差2例。优良率为85.7%。除1例下胫腓联合螺钉断裂外，无骨折感染、畸形愈合及不愈合发生。
手术治疗的关键是恢复踝关节解剖结构并最大程度恢复踝关节功能。
