Taylor G J, Allum R L
Northwick Park Hospital, Harrow.
J R Soc Med. 1988 Jan;81(1):19-21. doi: 10.1177/014107688808100109.
Loss of ankle movement is a complication of severe tibial fractures. This can be exacerbated if the foot is allowed to drop into equinus, particularly when an external fixator is employed. The range of ankle motion following external fixation of tibial fractures as compared to the opposite normal ankle was studied in 40 of 55 patients treated over a ten-year period. Nine were excluded due to other causes of ankle stiffness, leaving 31 cases for analysis. The mean follow up was 2 years 7 months (range 1 year to 8 years 3 months), and union had occurred by a mean of 35 weeks (range 9-100 weeks). The mean loss of ankle movement was 8 degrees of plantar-flexion and 12 degrees of dorsiflexion (overall loss 20 degrees), the difference between the two being highly significant (P greater than 0.001, t test). Loss of ankle motion closely paralleled the degree of soft tissue trauma, being 6 degrees for closed fractures and 22 degrees for open fractures (0.05 greater than P greater than 0.02). Ankle function is therefore at risk when a severe tibial fracture is treated by external fixation, and appropriate measures should be taken to preserve movement and prevent an equinus contracture.
踝关节活动丧失是严重胫骨骨折的一种并发症。如果让足部下垂呈马蹄足畸形，这种情况会加重，尤其是在使用外固定器时。在十年期间接受治疗的55例患者中，对其中40例患者胫骨骨折外固定术后踝关节的活动范围与对侧正常踝关节进行了研究。9例因其他导致踝关节僵硬的原因被排除，剩余31例用于分析。平均随访时间为2年7个月（范围1年至8年3个月），平均在35周（范围9 - 100周）时骨折愈合。踝关节活动的平均丧失为跖屈8度和背屈12度（总共丧失20度），两者之间的差异具有高度显著性（P大于0.001，t检验）。踝关节活动丧失与软组织创伤程度密切相关，闭合性骨折为6度，开放性骨折为22度（0.05大于P大于0.02）。因此，采用外固定治疗严重胫骨骨折时踝关节功能会受到影响，应采取适当措施保持活动并预防马蹄足挛缩。
