摘要
Abstract
Objective To explore methods for improving reduction quality of unstable ankle fractures through surgical treatment.Methods From January 2020 to January 2022,preoperative X-ray films of healthy ankle acupoints of patients were taken.Talocrural angle(TCA)of healthy ankle joint,Shenton line,medial clear space(MCS)of ankle joint,and superior clear space(SCS)of tibial joint,tibiofibular overlap(TFO),and lateral malleolus morphology(referred to as the hexaenet)were measured and observed,and compared with above indicators of C-arm X-ray fluoroscopy after intraoperative reduction and temporary fixation,compare whether there were changes in hexagram and adjust reduction treatment in a timely manner for 31 patients with unstable ankle fractures,included 18 males and 13 females;aged from 22 to 70 years old with an average of(45.1±7.2)years old;17 patients on the left side,14 patients on the right side;6 patients caused by sprains,13 caused by traffic injuries,and 12 caused by injuries from being hit by heavy objects;the time from injury to operation ranged from 1 to 11 days with an average of(4.5±1.6)days.There were 11 patients with severe comminuted fractures of lateral malleolus,12 pa-tients with bilateral malleolus fractures,and 8 patients with triple malleolus fractures.Among them,10 patients were combined with separation of inferior tibiofibular syndesmosis,and 3 patients were combined with injury of medial collateral ligament.The intraoperative reduction,fracture healing,complications were observed,and functional evaluation was conducted by American Orthopaedic Foot and Ankle Society(AOFAS)score at 12 months after operation.Results All 31 patients were followed up and the duration ranged from 12 to 20 months with an average of(14.5±1.2)months.C-arm X-ray fluoroscopy after intraopera-tive reduction and temporary fixation showed compared with healthy side,there were 9 patients of abnormal TCA,8 patients of abnormal Shenton line,11 patients of abnormal MCS,12 patients of abnormal SCS,3 patients of abnormal TFO,5 patients of abnormal lateral malleolus morphology,and 21 patients of abnormal combined judgment of the six signs.There were statistical-ly significant difference between combined judgment of the six signs and the judgment of a single indicator(P＜0.05).Twenty-six patients with normal bone healing,4 patients with delayed bone healing,and 1 patient with bone nonunion caused by bone resorption.There were no complications such as infection and skin necrosis.Postoperative AOFAS score at 12 months was(89.08±5.23)points,18 patients got excellent result,9 patients good,3 patients moderate and 1 patient poor.Conclusion Sur-gical treatment for unstable ankle fractures involves taking preoperative X-ray films of the healthy ankle points of patient,mea-suring and observing the hexagram to obtain personalized data.By comparing above indicators on the affected side with intra-operative fluoroscopy and adjusting the reduction,the quality of reduction could be effectively improved.关键词
踝关节骨折/不稳定/手术/复位质量/评估Key words
Ankle joint fractures/Unstable/Operation/Reduction quality/Judgment分类
医药卫生
