Salvage Operation for Neglected Ankle Fractures

在1986到1993年間，有49例延誤治療或治療不當之踝關節骨折接受手術矯治，術後平均追蹤36.4個月。這些病人包括31男性，18個女性，平均年齡為41.6歲，而從骨折到接受矯治期間平均17.6個月。手術治療是依患者骨折復位的情形及傷後性踝關節炎之程度加以分類而接受不同的手術。手術方法包括關節清理，觀血復位及內固定，下脛骨骨切術及關節融合術，全依個案不同的狀況而定。術後追蹤，所有的患者均有症狀舒解，且其踝功能評估從術前平均26.3分進步到追蹤時平均86.8分。踝關節骨折治療之目標和其他關節骨折一般，乃在於完全骨折復位及牢固的固定，如此才能早期活動，以得到好的功能回復。然而在延誤的踝關節骨折卻須考量其他因素，治療依情況而定：觀血復位術仍可用在尚無傷後性關節炎，或僅是輕度關節炎的患者，因為即使將來難免有些會發生關節炎，但經復位後的骨折在必要時接受下腔骨骨切術或踝關節融合術都會較容易成功。至於踝關節骨折延誤到已有相當關節炎者，踝關節融合術須以關節面加壓固定，足夠的植骨填補及固定在適當的位置，才能得到良好的結果。

關鍵字

無資料

並列摘要

From 1986 to 1993, 49 cases of untreated or poorly treated ankle fractures who received salvage surgery were followed up for an average of 36.4 months. The patients included 31 males & 18 females with an average age of 41.6y/o and the time interval from initial Injury to reconstructive surgery average due 17.6 months. They were classified and treated according to their grade of reduction and degree of arthrosis. The surgical methods included arthrotomy & joint debridement, revised open reduction, lower tibial osteoyomy and ankle arthrodesis, depending on different Individual conditons. After surgery, all cases had symptomatic relief and functional improvement with an average score increased from 26.3 preoperatively to 86.8 at follow up . The goals of ankle fractures is as articular fractures, they are treated by surgical anatomic reduction with rigid fixation as early as possible in order to provide good functional results. Nevertheless they are varied in neglected ankle fractures according to their individual conditions: open reductions were performed on cases with no or little arthritic change even though arthrosis might occur later because, If necessary, future conversion to osteotomy or arthrodesis would be easier. As for late cases with advanced arthritis, ankle arthrodesis were done by compressive arthrodesis with necessary bone graft to secure fusion in an optimal position.

並列關鍵字

ankle fracture ； traumatic arthritis

國際替代計量

Salvage Operation for Neglected Ankle Fractures

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