北京生物醫(yī)學(xué)工程

后踝骨折生物力學(xué)分析與臨床實踐

Biomechanical analysis and clinical practice ofposterior malleolus fracture

作者：許有銀王建光吳俊賢李玉民

單位：民航總醫(yī)院骨科(北京100123)

關(guān)鍵詞：后踝骨折；內(nèi)固定；生物力學(xué)分析；復(fù)位方式；治療

分類號：318.01;R683.42

出版年·卷·期（頁碼）：2020·39·3（303-307）

摘要：

目的通過對后踝骨折內(nèi)固定與非內(nèi)固定療效的生物力學(xué)分析,探討影響后踝骨折療效的主要因素?方法選取民航總醫(yī)院骨科2011年4月至2019年1月56例累及后踝關(guān)節(jié)骨折患者的臨床資料進(jìn)行回顧性分析?將56例患者分為后踝骨折內(nèi)固定組(后踝骨折塊≥25%的脛骨遠(yuǎn)端關(guān)節(jié)面,27例)與非內(nèi)固定組(后踝骨折塊<25%脛骨遠(yuǎn)端關(guān)節(jié)面,29例),比較兩組患者的治療效果?結(jié)果 56例患者12~30個月的隨訪結(jié)果表明,踝關(guān)節(jié)骨折均愈合?后踝骨折塊≥25%和<25%脛骨遠(yuǎn)端關(guān)節(jié)面均得到解剖學(xué)復(fù)位,兩組差異無統(tǒng)計學(xué)意義(P>05),AOFAS踝-后足評分差異無統(tǒng)計數(shù)學(xué)意義(P>05)?結(jié)論后踝骨折塊≥25%的脛骨遠(yuǎn)端關(guān)節(jié)面或移位大于2mm時,應(yīng)手術(shù)切開復(fù)位內(nèi)固定;后踝骨折塊<25%脛骨遠(yuǎn)端關(guān)節(jié)面可石膏外固定治療?因此,在臨床后踝骨折的患者可根據(jù)患者的具體情況選擇合適的治療方案,以取得更好的治療效果?

Objective To investigate the main factors influencing the curative effect of the posterior

Malleolus fracture by the biomechanical analysis of the internal fixation and nonfixation of the posterior malleolus fracture.Methods From April 2011 to January 2019, the clinical data of 56 patients with posterior malleolus fracture were analyzed retrospectively。They were divided into two groups:fixed group(27cases) and nonfixed group (29 cases). The therapeutic effect of the two groups was compared. Results 56 patients were followed up for 12 to 30 months. All ankle fractures healed.The difference in anatomic reduction between ≥25% and <25% was not statistically significant (P>05). The difference in AOFAS score was not statistically significant (P>05).Conclusions When the posterior in malleolus fracture mass ≥25% of the distal tibial　Joint surface or displacement > 2mm, open reduction and internal fixation should be performed. When the posterior malleolus fracture <25% of the distal tibial joint surface can be treated by plaster external fixation. Therefore. In the clinical patients with posterior malleolus fracture, we can choose the appropriate treatment plan according to the specific situation of the patients, so as to achieve better treatment effect.

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