[1]张瑞东,程义恒,袁宇,等.B型踝关节骨折的诊疗策略探讨[J].中国中医骨伤科杂志,2024,32(11):48-54.[doi:10.20085/j.cnki.issn1005-0205.241110]
　ZHANG Ruidong,CHENG Yiheng,YUAN Yu,et al.Diagnosis and Treatment Strategies for Type B Ankle Fractures[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(11):48-54.[doi:10.20085/j.cnki.issn1005-0205.241110]
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B型踝关节骨折的诊疗策略探讨()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年11期
页码:
48-54
栏目:
临床论著
出版日期:
2024-11-15

文章信息/Info

Title:
Diagnosis and Treatment Strategies for Type B Ankle Fractures
文章编号:
1005-0205(2024)11-0048-07
作者:
张瑞东1; 程义恒1; 袁宇1; 曲文庆1
1烟台市烟台山医院(山东 烟台,264000)
Author(s):
ZHANG Ruidong1; CHENG Yiheng1; YUAN Yu1; QU Wenqing1
1Yantaishan Hospital,Yantai 264000,Shandong China.
关键词:
踝关节;  骨折;  下胫腓联合损伤;  丝攻试验
Keywords:
ankle joint;  fracture;  syndesmotic injury;  wire tapping test
分类号:
R683.42
DOI:
10.20085/j.cnki.issn1005-0205.241110
文献标志码:
A
摘要:
目的:探讨Danis-Weber B型踝关节骨折的诊疗策略。方法:选取2020年5月至2023年2月收治的27例Danis-Weber B型踝关节骨折患者资料进行回顾性分析。术前应用X线检查、计算机断层扫描(CT)相关指标预判下胫腓联合损伤,术中应用丝攻试验证实。术前评估存在一定的误差及漏诊率,术中攻丝试验阳性率为40.7%,能够确切评估下胫腓联合损伤的程度,给予恰当的固定,避免了严重并发症的发生。对下胫腓联合不稳定病例直视复位并应用外径3.5 mm皮质骨螺钉固定。术后12周取出下胫腓螺钉,术后18个月随访,以美国足踝外科协会(AOFAS)踝与后足功能评分系统评估疼痛及踝关节功能,取得了良好的疗效。结果:27例患者中,下胫腓联合损伤的阳性率/误差比例分别为:X线下胫腓骨间隙(TFCS)33.0%/22.2%,下胫腓重叠(TFO)29.6%/37.5%; CT内踝间隙37.0%/10.0%,腓骨后骨折角51.8%/21.4%; 攻丝试验40.7%/0.0%。术后18个月AOFAS后足评分为(95.27± 4.67)分。结论:Danis-Weber B型踝关节骨折中,术前X线和CT检查仅可识别出一部分合并下胫腓联合损伤病例,CT检查的阳性率较高,误差比率较低; 术中丝攻试验可明确诊断,阳性率最高; 直视复位后以1枚外径3.5 mm皮质骨螺钉固定并于术后12周取出,指导患者功能锻炼可取得满意疗效。
Abstract:
Objective:To explore the diagnosis and treatment strategies for Danis-Weber type B ankle fractures combined with syndesmotic injuries.Methods:The data of 27 patients with Danis-Weber type B ankle fractures treated from May 2020 to February 2023 were selected for retrospective analysis.Preoperative X-ray and computed tomography(CT)related indicators were used to predict syndesmotic injury,and intraoperative wire tapping test was used to confirm this.There are some errors and missed diagnosis rate in preoperative evaluation.The positive rate of tapping test was 40.7%,which can accurately evaluate the degree of lower tibiofibular syndesmosis injury and give proper fixation to avoid serious complications.In cases of syndesmotic instability,reduction was performed under direct vision and fixed with 3.5 mm cortical bone screws.The tibiofibular screw was removed 12 weeks after the operation,and the pain and ankle joint function were evaluated with the American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot scale during the 18-month follow-up,and good results were achieved.Results:Among 27 patients,the positive rate/error ratio of syndesmotic injury was:X-ray tibiofibular space(TFCS)33.0%/22.2%,tibiofibular overlap(TFO)29.6%/37.5%; CT the medial malleolus gap was 37.0%/10.0%,the posterior fibular fracture angle was 51.8%/21.4%; the tapping test was 40.7%/0.0%.The AOFAS hindfoot score was(95.27± 4.67)points 18 months after surgery.Conclusion:In Danis-Weber type B ankle fractures,preoperative X-ray and CT examination can only identify some cases with syndesmotic injury.CT has a higher positive rate and a lower error rate; the intraoperative wire tapping test can identify the diagnosis is clear and the positive rate is the highest; after reduction under direct vision,a 3.5 mm cortical bone screw is fixed and removed 12 weeks after the operation,and functional exercises are guided to achieve satisfactory results.

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更新日期/Last Update: 2024-11-05