Roberts R S
Clin Orthop Relat Res. 1983 Jan-Feb(172):164-70.
To test the validity of the practice of open reduction and internal fixation for the treatment of displaced ankle fractures, 25 cases were reviewed after a mean follow-up period of 1.5 years. Eighty-eight per cent had satisfactory objective results and 76% satisfactory subjective results. Eight-eight per cent of the patients with good results had anatomic reductions, whereas none of those with poor results was anatomically reduced. No patient with anatomic reduction had early evidence of degenerative arthritis. There were no nonunions of the medial malleolus, and open fractures did not predispose to poor results. The pronation-eversion injury as classified by Lauge-Hansen was found to have the poorest results objectively, with 70% fair or poor subjectively. This observation is believed to be due to the complete ligamentous disruption of the syndesmosis, which, unlike intraosseous diastasis, fails to heal solidly in a high percentage of patients. This study indicates that good results can be achieved by open reduction and internal fixation when exact anatomic reduction is achieved. The pronation-eversion injury remains a difficult problem. Better methods of treatment for this injury are needed.
为检验切开复位内固定治疗移位型踝关节骨折方法的有效性，我们对25例患者进行了回顾性研究，平均随访时间为1.5年。结果显示，88%的患者获得了满意的客观疗效，76%的患者获得了满意的主观疗效。疗效良好的患者中，88%实现了解剖复位，而疗效不佳的患者中无一例实现解剖复位。解剖复位的患者均未出现早期退行性关节炎迹象。内踝无骨不连情况，开放性骨折也未导致疗效不佳。Lauge-Hansen分类中的旋前-外旋型损伤客观疗效最差，主观上70%的患者疗效为一般或较差。据信，这一观察结果是由于下胫腓联合韧带完全断裂所致，与骨间膜分离不同，在很大比例的患者中，下胫腓联合韧带无法牢固愈合。本研究表明，当实现精确的解剖复位时，切开复位内固定可取得良好疗效。旋前-外旋型损伤仍然是一个难题，需要更好的治疗方法。
