摘要目的 探讨踝关节脱位法治疗包含复杂后踝骨折的脱位型三踝骨折的治疗方式和临床疗效. 方法 自2000年6月至2009年6月收治复杂后踝骨折的脱位型三踝骨折患者29例,男19例,女10例,年龄20～67岁,平均37岁；损伤根据Lauge-Hansen分类:旋后外旋型18例,均为Ⅲ度；旋前外展型11例,均为Ⅳ度.骨折按照Danis-Weber(AO/ASIF)分型:B型19例,C型10例.患者均采用踝关节外侧脱位法,充分显露后踝,直视下复位骨折块,用可吸收螺钉可靠固定.术后疗效采用Baird-Jackson评分进行评定. 结果 本组患者手术时间为45～85 min,平均65 min.术后1例患者伤口二期愈合,其他均一期愈合.所有患者术后获8～30个月(平均14个月)随访,均达骨折临床愈合,愈合时间3～5个月(平均4个月),无一例发生距骨坏死.无内固定物松动、脱出、断裂等发生.术后疗效按Baird-Jackson评分评定:优20例,良7例,可2例,优良率为93.1％.结论 对于包含复杂后踝骨折的脱位型三踝骨折的术中复位采用踝关节脱位法可以使关节软骨面精确复位,治疗效果良好.

abstractsObjective To discuss the effect of dislocating the ankle joint in treatment of dislocated trimalleolar fracture accompanied with a complicated hock fracture.Methods From June 2000 to June 2009,29 patients were treated in our department by dislocating the ankle joint for dislocated trimalleolar fracture accompanied with a complicated hock fracture.They were 19 men and 10 women,aged from 20 to 67 years (average,37 years).According to the Lauge-Hansen classification,there were 18 cases of supination-external rotation type Ⅲ and 11 cases of pronation-external rotation type Ⅳ.According to the Danis-Weber (AO/ASIF) system,there were 19 cases of type B and 10 cases of type C.A medial malleolus incision was made to dislocate the ankle joint and to expose the hock before reduction of bone fragments under direct visualization followed by rigid fixation with absorbable screws.The Baird-Jackson evaluation system was used to assess surgical outcomes.Results The operating time averaged 65 minutes,ranging from 45 to 85 minutes.All wounds healed at the first stage except one that healed at the secondary stage.The patients obtained an average follow-up of 14 months (from 8 to 30 months).All fractures achieved clinical union after 3 to 5 months (average,4 months) postsurgery.No talar necrosis or implant failure occurred.By the Baird-Jackson evaluation system,20 cases were excellent,7 good and 2 fair,giving a good to excellent rate of 93.i ％.Conclusion Dislocating the ankle joint can help achieve precise reduction of the articular cartilages and consequently satisfactory results in the treatment of dislocated trimalleolar fracture accompanied with a complicated hock fractures.