Li Bo-Hua, Wang Shan-Xi, Li Jun, Huang Fu-Guo, Xiang Zhou, Fang Yue, Zhong Gang, Yi Min, Zhao Xiao-Dan, Liu Lei
Department of Orthopedics, West China Hospital of Sichuan University, Chengdu 610041, China.
Department of Orthopedics, West China Hospital of Sichuan University, Chengdu 610041, China.
Chin J Traumatol. 2018 Aug;21(4):193-196. doi: 10.1016/j.cjtee.2018.03.004. Epub 2018 Jun 2.
To investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice.
This study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17-73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6-14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8-10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded.
All the 22 patients were followed up for 24-63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases).
In the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.
探讨切开复位内固定（ORIF）联合经关节外固定（TEF）但不修复三角韧带（DLR）治疗旋后-外旋IV型等效（SER IV E）踝关节骨折（AO/OTA分类44-B 3.1）的早期和中期结果，为临床实践提供依据。
本研究队列包括22例2011年12月至2014年12月期间接受ORIF联合TEF但未行DLR治疗的SER IV E踝关节骨折患者。其中男性13例，女性9例，平均年龄38.9岁（范围17 - 73岁）。8例累及左侧，14例累及右侧。骨折原因包括道路交通事故（11例）、高处坠落（6例）和运动损伤（5例）。平均住院时间为9.8天（范围6 - 14天）。所有患者术前均行MRI和三维CT检查，术前及随访期间行X线检查。外固定架保留8 - 10周。术前美国矫形足踝协会（AOFAS）踝-后足评分为56.86 ± 4.400，医学结局简明36项问卷（SF-36）评分为57.41 ± 4.102，视觉模拟评分（VAS）为5.50 ± 1.058。还记录了患者关于日常生活不便的主要抱怨。
22例患者均获随访24 - 63个月（平均33.6个月）。随访期间均未发生骨不连；1例患者出现针道感染，另1例出现创伤后骨关节炎。末次随访时，平均AOFAS评分、SF-36评分和VAS评分分别为90.59 ± 5.096、79.59 ± 5.394和1.82 ± 1.181，与术前数据相比有显著改善（t = 26.221，p < 0.001；t = 11.910，p < 0.001；t = 11.571，p < 0.001）。疗效优13例，良7例，可2例，优良率为90.9%。患者的主要抱怨是穿衣不便（17例）和肢体清洁不便（5例）。
在治疗SER IV E踝关节骨折时，ORIF联合TEF但不修复DLR可取得满意疗效，但长期效果有待大样本随机对照试验证实。
