Objective To investigate the clinical significance of the arthroscopy in the treatment of ankle fractures. Methods Totally 26 cases of ankle fracture that underwent ankle arthroscopy from December 2009 to July 2011 were retrospectively analyzed. The arthroscopic procedures included debridement, repairing articular cartilage, reduction and fixation of the fracture, and rebuilding the damaged ligaments. Modified McGuire scoring system was used for evaluating clinical therapeutic effect. Results 6 cases had cartilage injury on the tibial articular surface and talus articular surface; 12 cases had cartilage injury on the talus medical articular surface, among whom, 5 case were complicated with medial malleolus injury, and the other one showed lateral malleolus and medial malleolus injury; 8 cases had cartilage injury on the lateral malleolus and the lateral talus surface, among whom, 1 case was complicated with medial malleolus and talar body injury. All the cases received operation by arthroscopy, among whom, the cartilage fragment was removed in 11 cases, cartilage reduction and fixation were given in 9 , and articular surface trimming was carried out in 6 eases. With subtalar arthroscopy, we found that 5 cases had cartilage injury and ligament injury, and 3 cases had talocalcaneal ligament rupture. All the injuries were repaired by arthroscopy. The operation time ranged from 40 to 160 minutes with a mean of 90 minutes. The blood loss was 100 ml in average ( 10 - 300 ml). No patient developed injuries to the nerve or vascular system, nor ankle infection. Primary healing was achieved in all the cases. Modified McGuire scoring system showed excellence ( 81 - 100 ) in 15 cases, good ( 71 — 80 ) in 9, fair ( 65 —70 ) in 2, and poor ( < 65) in none in 3 months after the operation. We followed up the patients for a mean of 9 months (3 —24 months) ; the bone fracture was healed in all the cases. Conclusions With the assistance of arthroscopy, we can accurately reposition the anatomical structure of the articular surface and treat the consolidated injuries at the same time with a minor trauma. The procedure produces satisfactory clinical results.%目的 探讨踝关节镜在踝关节骨折治疗中的价值. 方法 2009年12月～ 2011年7月26例踝关节骨折在踝关节镜下探查踝关节腔,清理撕裂韧带、水肿滑膜、损伤软骨,在踝关节镜辅助下复位、固定骨折,修复、重建损伤的韧带.结果 软骨损伤部位同时累及胫骨远端关节面及距骨上关节面6例；累及距骨内侧面12例,其中5例同时合并内踝损伤,1例同时合并内、外踝损伤；同时合并外踝及距骨外侧面损伤8例,其中1例同时合并内踝及距骨体部损伤.关节镜下软骨碎片取出术11例,软骨复位固定9例,关节面修整、微骨折术6例；距下关节镜检查示软骨损伤及韧带松弛5例,距跟韧带断裂3例,均在关节镜辅助下行修复重建术.手术时间40 ～160 min,平均90 min;术中出血量10 ～300 ml,平均100 ml.术中均无神经、血管损伤,术后无感染病例,切口一期愈合.术后3个月采用改良McGuire评分系统评定临床疗效:优15例(81 ～ 100分),良9例(71～ 80分),可2例(65 ～70分).26例随访3～ 24个月,平均9个月,骨折全部愈合. 结论 踝关节镜辅助治疗踝关节骨折能够精确解剖复位关节面,及时发现、处理软骨、韧带等合并损伤,创伤小,治疗效果满意.
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