摘要
目的:探讨丝攻试验联合纽扣钢板在诊断和治疗踝关节骨折合并下胫腓联合不稳中的临床疗效。方法:本组24例,男14例,女10例;年龄24~74岁,平均46.8岁。其中Lauge-Hansen分型旋后-外旋Ⅳ度6例;旋前-外旋型Ⅳ度8例;旋前-外展型Ⅱ度4例,Ⅲ度6例。在行踝关节骨折切开复位内固定术时,24例均行丝攻试验证实下胫腓联合不稳定,采用纽扣钢板线缆系统行下胫腓联合弹性固定。结果:术后随访时间7~24个月,平均15.5个月。无伤口感染不愈、钢板松动断裂下沉及下胫腓联合复位丢失情况。术后6个月按照AOFAS踝-后足评分标准:优21例,良2例,可1例。结论:丝攻试验是一个简单、安全、客观、评判标准一致、诊断特异性敏感性均较高的下胫腓联合不稳定术中诊断方法。纽扣钢板线缆系统具有能自发性复位,允许下胫腓微动,不良复位率低和良好的生物力学优势,负重功能锻炼更早等优点。两者结合在诊断和治疗踝关节骨折合并下胫腓联合不稳中,有操作方法简单,流程顺畅无反复,安全且诊断标准一致不易漏诊,固定牢固稳妥并且不需特意取出,疗效确切,并发症、后遗症较少的优势,值得推广应用。
Objective:To analyze the clinical efficacy of the diagnosis and treatment of the tap test combined with endobutton plate cable system in the ankle fracture merging instability of tibiofibular syndesmosis.Methods:There were 14 males and 10 females with an average age of 46.8 years old(24 to 74 years old).There were 6 cases of supination external rotation Ⅳ degree, 8 cases of pronation external rotation Ⅳ degree, 4 cases of pronation abduction Ⅱ degree and 6 cases of degree Ⅲ according to Lauge-Hanson typing.During the surgical operation of ankle fractures, all 24 cases were tested by the tap test to verify the instability of tibiofibular syndesmosis.The Endobutton plate cable system was used for the elastic fixation of the tibiofibular syndesmosis.Results:All patients were followed up for 7 to 24 months(with 15.5 months on average).There was no wound infection, plate loosening, fracture, subsidence, and reduction loss of tibiofibular syndesmosis.All the patients were assessed by American orthopedic foot and ankle society(AOFAS) ankle and hind-foot score.21 cases were excellent after operation 6 months, 2 cases were good and 1 case was fair.Conclusion:The tap test is a simple, safe, objective, consistent evaluation standard and high sensitivity diagnostic methods of tibiofibular syndesmosis instability.The endobutton plate cable system has the advantages of spontaneous reduction, allowing the lower tibiofibular micro motion, low rate of bad reduction, good biomechanical advantages, and earlier weight-bearing exercise.The combination of the two methods in the diagnosis and treatment of ankle fracture combined with tibiofibular instability reveals advantages of simple operation method, smooth process, no repetition, safety, consistent diagnostic criteria, not easy to miss diagnosis, reliable and stable fixation and no need to take it out specially, exact curative effect and less complications, which is worthy of wide application.
作者
吴伟
刘晓峰
WU Wei;LIU Xiaofeng(Department of Traumatic Orthopedics,Wuxi Hospital of Traditional Chinese Medicine,Wuxi 214000,Jiangsu China)
出处
《中国中医骨伤科杂志》
CAS
2021年第5期77-80,共4页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
踝关节
骨折
下胫腓
丝攻试验
纽扣钢板
固定
ankle joint
fracture
tibiofibular
tap test
endobutton fixation
