Olerud C, Molander H
Clin Orthop Relat Res. 1986 May(206):253-60.
The results of bi- and trimalleolar fractures treated with nonrigid internal fixation were analyzed in 134 patients. The fractures were of both pronation and supination type. The operative success was evaluated in terms of congruency as seen on the post-operative radiographs. The congruency was classified as either congruent, small, or grave displacement respectively. At follow-up evaluation, four variables were recorded: a linear analogue scale, an ankle score, range of motion, and presence of osteoarthritis. Fifty percent had congruent joints, 20% had small, and 30% had grave displacements. At follow-up examination those with congruent joints had significantly better function than those with displacements in all four variables. There were only minor differences between the two displacement groups. The nonrigid technique seems inadequate in retaining congruency of the unstable bi- and trimalleolar fractures. Congruency is the key to good prognosis. Even minor displacement significantly increases the risk of impending disability.
对134例采用非刚性内固定治疗的双踝和三踝骨折患者的结果进行了分析。骨折包括旋前型和旋后型。根据术后X线片上的关节面一致性来评估手术成功率。关节面一致性分别分为完全一致、轻度移位或严重移位。在随访评估中，记录了四个变量：线性模拟量表、踝关节评分、活动范围和骨关节炎的存在情况。50%的患者关节面完全一致，20%的患者轻度移位，30%的患者严重移位。在随访检查中，关节面完全一致的患者在所有四个变量方面的功能明显优于有移位的患者。两个移位组之间只有微小差异。非刚性技术似乎不足以保持不稳定的双踝和三踝骨折的关节面一致性。关节面一致性是预后良好的关键。即使是轻微移位也会显著增加即将出现残疾的风险。
