中文摘要：

背景：近年来,手术治疗合并糖尿病的踝关节骨折病例不断增加。如何控制围术期血糖,降低术后伤口不愈合,感染以及骨折不愈合的风险,是手术治疗成功的关键。目的：研究老年糖尿病患者踝关节骨折的手术治疗效果。方法：2010年1月至2015年10月手术治疗老年急性闭合性踝关节骨折87例。20例合并糖尿病,男3例,女17例：年龄62-80岁,平均68.6岁。非糖尿病组患者67例,男30例,女37例：年龄60-85岁,平均66.1岁。比较两组患者术后伤口拆线时间,伤口并发症,术后感染,骨折愈合情况以及AOFAS评分。结果：85例患者获得随访。随访时间7-76个月,平均34.6个月。两组患者术后伤口拆线时间及AOFAS评分比较均无统计学差异（P〉0.05）。非糖尿病组有2例患者术后出现外踝伤口不愈合,换药治疗后伤口愈合。糖尿病组有2例患者术后内踝伤口不愈合,换药治疗后伤口愈合;2例患者术后出现外踝伤口感染,二次手术清创并取出外踝内固定物。所有患者的骨折均愈合。结论：在不伴有靶器官损害的老年糖尿病患者中,手术治疗踝关节骨折可以取得满意的疗效。在伴有靶器官损害的患者中,术后并发症的发病率较高。仔细的术前评估,良好的围手术期血糖控制,合理的分期手术,术中小心的软组织处理,坚强的骨折内固定,术后的保护性制动以及避免早期负重是取得良好治疗效果的关键。

英文摘要：

Background：There is a increasing trend in the treatment of ankle fracture by surgery.But how to control perioperative serum glucose,incidence the incidence of wound nonunion,infection and bone nonunion are the key points for successful surgical treatment.Objective：To evaluate outcomes of surgical treatment for ankle fractures in elderly patients with diabetes.Methods：Totally 87 patients with ankle closed fractures treated surgically from January 2010 to October 2015 were enrolled in this study.Of them,20（3 males and 17 females with a mean age of 68.6 years ranging from 62 to 80 years）suffered from diabetes.Sixty-seven patients（30 males and 37 females with a mean age of 66.1 years ranging from 60 to 85years） without diabetes were assigned into control group.Postoperative suture-out time,wound complications,infection,bone union and AOFAS scores were compared between patients with and without diabetes.Results：Eventually,85 patients were followed up 34.6 months on average（ranging from 7 to 76 months）.There were no significant difference in the sutureout time or AOFAS scores between patients with and without diabetes（P〈0.05）.The wound did not heal in the lateral malleolus in 2 patients of control group and were cured by dressing change.In diabetes group,the wound did not heal in the medial malleolus in 2 patients of and were also cured by dressing change,and wound infection occurred in lateral malleolus in another 2 patients who were treated with debridement and removal of internal fixations.All fractures were healed finally.Conclusions：Surgical treatment for ankle fractures in elderly diabetic patients without target organ injury can achieve satisfactory outcomes.The incidence of postoperative complications is high in patients with target organ injury.Careful preoperative evaluation,good glycemic control,staging operation,cautious soft tissue management,stable internal fixation,postoperative protected immobilization as well as prolonged non-weight-bearing are crucial to obtain a good outco