王国锋

[摘要] 目的 探讨不同治疗方式在旋后外旋型Ⅲ、Ⅳ度踝关节骨折中的应用效果。 方法 选取2015年1～6月我院骨科收治旋后外旋型Ⅲ、Ⅳ度踝关节骨折患者，共80例。根据保守疗法、手术疗法适应证进行分组，保守组和手术组各40例。比较两种治疗方式在踝关节功能症状改善情况以及住院时间、并发症发生率方面的差异。 结果 手术组旋后外旋型Ⅲ度患者经治疗后优良率为94.44%（17/18），明显高于保守组（P<0.05）。保守组旋后外旋型Ⅳ度患者住院时间为（10.2±0.3）d，明显低于手术组（P<0.05）。两组旋后外旋型Ⅲ度、Ⅳ度患者并发症发生率比较，差异无统计学意义（P>0.05）。 结论 切开复位内固定手术治疗与保守方法治疗对旋后外旋型Ⅲ、Ⅳ度踝关节骨折患者均有一定的治疗效果，但对于Ⅲ度骨折患者而言，选用切开复位内固定手术疗法更有利于患者踝关节症状功能的改善，而对于Ⅳ度骨折患者而言，选用保守方法的住院时间更短，并发症发生率较低，提示临床需谨慎选用治疗方法。

[关键词] 踝关节骨折；旋后外旋型；并发症

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2016）07-0052-03

[Abstract] Objective To investigate the effects of different treatment modalities in supination external rotation type Ⅲ， Ⅳ degree ankle fracture application effect. Methods From January to June 2015 in our hospital，selected 80 cases with orthopedic admitted supination external rotation type Ⅲ， Ⅳ degree ankle fracture patients，according to conservative treatment， indications for surgical therapy group， the conservative group included 40 patients， the surgery group included 40 patients.The ankle function improvement of symptoms and hospitalization time，the complication rate aspect were compared. Results The surgery group rotation external rotation type Ⅲ patients after treatment was 94.44% excellent （17/18），significantly higher than the conservative group， by testing data comparison was statistically significant between two groups（P<0.05）. Conservative group Ⅳ supination external rotation patient hospital stay was（10.2±0.3） d，significantly lower than the surgery group， data comparison between groups was statistically significant（P<0.05）. Two supination external rotation degree Ⅲ，Ⅳ degree complication rates had no significant difference（P>0.05）. Conclusion Open reduction and internal fixation surgery and conservative approach to treatment of supination external rotation type Ⅲ， Ⅳ degree ankle fracture patients have a therapeutic effect， but the degree to Ⅲ fracture patients， the choice of open reduction and internal fixation Therapy is more conducive to improve the symptoms of patients with ankle function， and for the degree Ⅳ fracture patients， the choice of a conservative approach of shorter hospital stays， lower complication rate， suggesting that the choice of clinical treatment need to be cautious.

[Key words] The ankle fracture； After turning the screw type； Complications

踝关节骨折为骨科多发性关节内骨折病症，约占全身骨折3.9%左右[1-3]。踝关节骨折中又以旋后外旋型骨折常见，此类骨折是当足处于后旋位置时，距骨受外旋力或小腿内旋时距骨受相对外旋外力影响所致骨折[4]。临床将此类骨折纳入不稳定性骨折范畴中。目前针对旋后外旋型Ⅲ、Ⅳ度踝关节骨折可采取的治疗方法包括手术治疗、保守治疗两类。不同治疗方法具有相应的优势，临床在选择治疗方法时尚无统一标准[5-6]。为探讨观察不同治疗方式在旋后外旋型Ⅲ、Ⅳ度踝关节骨折中的应用效果，本研究分析2015年1～6月我院骨科收治旋后外旋型Ⅲ、Ⅳ度踝关节骨折患者共80例采取保守、手术疗法的疗效，现报道如下。……