Objective:To explore therapeutic effects of bone setting manipulation for the treatment of over degree Ⅱ supination-eversion fractures of ankle, and analyze manipulative reduction mechanism. Methods: From 2005 to 2008,95 patients with over degree Ⅱ supination-eversion fractures of ankle were treated respectively by manipulation and operation. There were 43 cases[11 males and 32 females with an average age of(44.95±12.65 )years] in manipulation group,and 2 cases were degree Ⅱ , 11 cases were degree Ⅲ ,and 30 cases were degree Ⅳ. There were 52 cases [21 males and 31 females with an average age of(39.96±13.28)years]in operative group,and 6 cases were degree Ⅱ , 18 cases were degree Ⅲ,and 28 cases were degree Ⅳ. Bone setting manipulation and hard splint external fixation were applied to manipulative group. Operative reduction internal fixation was performed in operative group. X-ray was used to evaluate reduction of fracture before and after treatment, 2 months after treatment. Ankle joint function was evaluated according to Olerud-Molander scoring system after 6 months treatment. Results: All patients were followed up with good reduction. Three cases occurred wound complication in operative group, but not in manipulative group. In manipulation group, 19 cases got excellent results,20 cases good and 4 cases fair; while in operative group, 30 cases got excellent results, 20 cases good and 2 cases poor. There were no significant differences in fracture reduction and ankle joint function recovery between two groups (P>0.05). Efficacy of operative treatment was better than that of manipulative treatment at degree IV fracture (P<0.05). Conclusion: Bone setting manipulation is a good method for treating supination-eversion ankle joint fractures, which has advantages of simple and safe operation .reliable efficacy. For ankle join fracture at degree Ⅳ,manipulative reduction should be adopted earlier,and operative treatment also necessary.%目的:探讨四步正踝手法复位治疗Ⅱ度以上旋后外旋型踝关节骨折的疗效,分析其复位机制.方法:自2005年至2008年治疗95例新鲜Ⅱ度以上旋后外旋型踝关节骨折,分手法组和手术组.其中手法组43例,男11例,女32例；平均年龄(44.95±12.65)岁；骨折分度:Ⅱ度2例,Ⅲ度11例,Ⅳ度30例.手术组52例,男21例,女31例；平均年龄(39.96±13.28)岁；骨折分度:Ⅱ度6例,Ⅲ度18例,Ⅳ度28例.手法组采用四步正踝法闭合复位、硬纸夹板外固定；手术组采用切开复位内固定治疗.骨折治疗前后、治疗后2个月时通过X线片检查评估骨折对位情况；骨折治疗后6个月后通过Olerud-Molander评分系统评价疗效及踝关节功能恢复情况.结果:95例均获随访,所有患者骨折愈合,手术组3例出现伤口并发症,手法组无不良反应.术后6个月手法组,优19例,良20例,可4例；手术组,优30例,良20例,可2例.2组在骨折对位情况、踝关节功能恢复情况等方面差异无统计学意义(P＞0.05),Ⅳ度骨折手术治疗疗效优于手法治疗(P＜0.05).结论:四步正踝法治疗旋后外旋型踝关节骨折简便安全、疗效可靠,Ⅳ度骨折建议早期闭合复位,必要时手术治疗.
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