摘要
背景:闭合性不稳定踝关节骨折患者通常会在术前等待1~2周以期改善软组织条件,往往造成骨折复位丢失、骨折断端粘连严重,手术复位困难。目的:探讨临时外固定架撑开治疗严重急性闭合性不稳定踝关节骨折的安全性和有效性。方法:回顾性分析2017年9月至2018年6月行临时外固定架撑开术治疗的13例踝关节骨折患者,男5例,女8例。年龄31~89岁,平均62.1岁。踝关节骨折均为三踝骨折,累及外踝、内踝和后踝。记录术前及术后1 d踝关节的疼痛视觉模拟评分(VAS),初次治疗至最终切开复位内固定手术间隔时间,踝关节骨折复位的维持效果以及手术相关并发症。结果:所有患者术前VAS评分6~10分,平均(7.8±1.0分);术后1 d的VAS评分3~5分,平均(3.9±1.1)分,两者比较差异有统计学意义(P<0.05)。外固定架固定术后至骨折切开复位内固定术的手术间隔时间为5~7 d,平均(5.7±0.8)d。1例89岁女性患者术后出现跟骨固定针的松动,骨折复位丢失。所有患者均未发现针道感染。结论:在严格把握适应证的情况下,临时外固定撑开治疗急性闭合性不稳定踝关节骨折可以减轻患者疼痛、方便患者生活、降低护理难度、有效维持外踝长度、减少骨折块移位、为择期手术创造良好的软组织条件,是一种简便、安全、有效的治疗手段。
Background:Patients with closed unstable ankle fractures usually wait for 1 to 2 weeks before operation in order to improve soft tissue conditions,which often results in loss of fracture reduction,severe adhesion at the broken end of the fracture,and difficulty in surgical reduction.Objective:To investigate the safety and efficacy of temporary external fixation in the treatment of severe acute closed unstable ankle fractures.Methods:Thirteen patients with ankle fracture treated by temporary external fixation from September 2017 to June 2018 were retrospectively analyzed.There were 5 males and 8 females with an average of 62.1 years(range,31-89 years).All the fractures were classified as trimalleolar fracture involving the lateral,medial and posterior malleolus.Visual analogue scale(VAS)of the ankle,interval time between initial treatment and open reduction and internal fixation,maintenance of fracture reduction and complications were recorded.Results:The mean VAS score was 3.9±1.1(range,3-5)one day after operation,which was significantly lower than preoperative one(mean 7.8±1.0,range 6-10,P<0.05).The mean interval time between two treatments was(5.7±0.8)d(range,5-7 d).An 89-year-old female patient suffered from loosening of calcaneal fixation needle and loss of fracture reduction.No needle tract infection was found in any patient.Conclusions:Temporary external fixation for the treatment of acute closed unstable ankle fractures can alleviate the pain,facilitate the life of patients,reduce the difficulty of nursing,effectively maintain the length of the lateral malleolus,and decrease the displacement of fracture blocks under strict control of indications.It is a simple,safe and effective treatment to create good soft tissue conditions for selective surgery.
作者
袁玉松
芦浩
吕昊润
徐海林
YUAN Yusong;LU Hao;LV Haorun;XU Hailin(Department of Orthopedics,Peking University People's Hospital,Beijing 100044,China)
出处
《中华骨与关节外科杂志》
2019年第9期700-703,共4页
Chinese Journal of Bone and Joint Surgery
基金
北京市科技计划项目(新)(Z181100001718159)
教育部创新团队(IRT_16R01)
关键词
踝关节骨折
外固定
撑开
Ankle Fracture
External Fixation
Distraction
