田方云

[摘要] 目的：探讨开放性踝关节骨折脱位的手术方法和治疗效果。方法：我院2004年8月~2010年6月收治38例开放性踝关节脱位骨折患者并进行手术，术后34例经过5~26个月的随访，平均13个月，应用改良的Baird和Jackson评分系统对其疗效进行评定。结果：优19例，占55.9%；良12例，占35.3%；可2例，占5.9%；差1例，占2.9%。优良率为91.2%。结论：手术治疗开放性踝关节骨折脱位疗效确切，伤口的早期处理、对骨折类型的判断、固定方法的选择是提高复位质量及改善远期疗效的关键。

[关键词] 开放性骨折；踝关节脱位；手术；内固定

[中图分类号] R683.42 [文献标识码]B[文章编号]1673-7210（2011）11（c）-180-02

Efficacy analysis of open ankle fracture and dislocation

TIAN Fangyun

Department of Surgery, Hu′nan Coal Industry Group Chenxi Industry Limited Company Hospital in Chenxi County, Hu′nan Province, Huaihua 419500, China

[Abstract] Objective: To investigate the the surgical methods and treatment effect of open ankle fracture and dislocation. Methods: 38 cases of open ankle fracture and dislocation in our hospital from August 2004 to June 2010 were given surgery treatment, 34 cases were followed up for 5-26 months (average 13 months), efficacy was assessed by modified Baird and Jackson scoring system. Results: Effect was excellent in 19 cases(55.9%), good in 12 cases(35.3%), basic improvment in 2 cases(5.9%), poor in 1 case(2.9%), excellent and good rate was 91.2%. Conclusion: Surgical treatment of open ankle fracture dislocation is effective, early treatment of the wound, the judge of fracture type and fixed method are the keys to improve quality of reduction and long-term effect.

[Key words] Open fractures; Ankle dislocation; Surgery; Fixation

近年来随着社会的发展，交通事故日益增加，开放性踝关节骨折脱位的发生也逐渐增多，踝关节是人体重要的负重关节，生理功能要求高，如发生骨折脱位，损伤的不仅是骨性结构，其韧带和软组织也同时存在复合损伤。因此，伤口、骨折、脱位早期的处理和复位，术后治疗及功能锻炼对患者的恢复至关重要。我院2004年8月~2010年6月手术治疗开放性踝关节骨折脱位38例，34例获得随访，取得良好效果，现报道如下：

1资料和方法

1.1一般资料

本组38例患者中，男24例，女14例；年龄20~55岁；车祸伤8例，坠落伤17例，砸伤13例。失访4例。伤后就诊时间：4 h内者27例，4~8 h者9例，20 h者2例。受伤部位：内踝部25例，外踝部13例。骨折分型根据Lange-Hanson分类法：旋后外旋型10例，旋前外旋型12例，旋前外展型9例，旋后内收型7例。踝部骨折情况：单踝骨折10例，双踝骨折23例，三踝骨折5例；合并腓骨骨折10例，距骨骨折5例，跟骨骨折4例。均伴有不同程度的踝关节外露，其中合并局部皮肤大片撕脱伤13例，软组织缺损面积最大达16 cm2，伤口污染严重8例。……