摘要目的 探讨应用低切迹解剖支撑钢板治疗垂直型内踝骨折的疗效. 方法 采用回顾性病例系列研究分析2013年2月—2015年2月收治的20例垂直型内踝骨折患者临床资料,其中男13例,女7例;平均年龄45.8岁.单纯内踝骨折1例,合并外踝骨折11例,合并外、后踝骨折6例,合并外踝、胫骨远端骨折2例.均采用低切迹解剖支撑钢板固定治疗.评估骨折愈合、复位丢失、内固定稳定性、骨关节炎发生等情况.术后踝关节功能按照美国足踝外科协会(AOFAS)踝与后足评分进行评估. 结果 患者均获随访18～37个月,平均26.5个月.X线片复查示踝关节均获解剖复位.骨折均愈合,平均愈合时间15.6周.术后8～16周可正常行走并返回岗位,平均12.5周;术后20～26周可进行体育锻炼,平均22.5周.随访期间无复位丢失、内固定物松动及断裂等并发症发生;未出现骨不连骨不愈合,未出现骨关节炎影像学表现.末次随访时,患者AOFAS踝与后足评分为75 ～ 100分,平均88.6分;其中优13例,良7例,优良率100％.结论 低切迹解剖支撑钢板治疗垂直型内踝骨折具有固定牢靠、术后患者可早期锻炼、功能恢复良好等优点,是治疗此类较特殊型骨折比较合适的选择.

abstractsObjective To investigate the efficacy of low-profile anatomical buttress plate in treating vertical shear medial malleolus fractures.Methods A retrospective case series study was conducted on the clinical data of 20 patients with vertical shear medial malleolus fractures admitted from February 2013 to February 2015.A total of 13 males and seven females were included in the study,with an average age of 45.8 years.There were 11 patients with medial combined with lateral malleolus fractures,one with medial malleolus fracture,six with medial combined with posterior and lateral malleolus fractures,and two with medial combined with distal tibial fractures.All patients were treated with low-profile anatomical buttress plate.Bone union,reduction loss,internal fixation stability,and incidence of ostearthritis were recorded.The postoperative ankle function was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) score.Results All patients were followed up for26.5 months on average (range,18-37 months).Anatomical reduction was seen in all patients according to X ray.Patients were seen bone union after an average of 15.6 weeks.After 8-16 weeks,patients were able to walk and return to work,averaging 12.5 weeks.Patients were able to do physical exercise after 20-26 weeks (mean,22.5 weeks).The follow-up showed no complications such as reduction loss,internal fixation loosening or breakage.Bone nonunion was not seen,and no manifestation of osteoarthritis was shown in the images.An average AOFAS score of 88.6 points (range,75-100 points) was reported at the final follow-up.The scoring outcome was excellent in 13 patients and good in seven,with excellent and good rate of 100％.Conclusions The low-profile anatomical buttress plate for fixation of vertical shear medial malleolus fractures has advantages of firm fixation,early mobilization and sound function recovery.The plate can be a safe and effective method for the treatment of vertical shear medial malleolus fractures.