俯卧位后外侧入路联合内侧切口治疗三踝骨折35例的临床疗效评价  

Evaluation of the Clinical Efficacy of Posterolateral Approach for Open Reduction and Internal Fixation in the Treatment of Trimalleolar Ankle Fractures

作　　者：张强[1] 刘国辉[1] 林浩东[1] 侯春林[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200001

出　　处：《现代生物医学进展》2016年第14期2660-2662,共3页Progress in Modern Biomedicine

摘　　要：目的：探讨在俯卧体位下采用后外侧入路联合内侧切口治疗三踝骨折方法的临床疗效及安全性。方法：选择2014年1月~2015年1月在我院治疗并由同一治疗组医生采用俯卧体位下治疗的三踝骨折患者35例,治疗外踝骨折时将钢板置于腓骨后侧或外侧,使用钢板或螺钉对后踝骨折进行固定,2枚拉力螺钉固定内踝。观察术后切口及骨折愈合、踝关节功能恢复情况。术后定期随访,采用AOFAS踝-后足评分标准对踝关节功能进行评价。结果：手术时长50~142 min,平均90 min,1例患者内侧切口出现局部红肿,抬高患肢及定期换药后局部红肿好转,未出现明显切口感染征象。2例病人术后出现足背部麻木,分别在术后6周、9周时消失。随访时间6~18月,平均随访15个月。术后3月X线显示所有病人骨折线模糊,骨痂生长良好,按美国足踝外科协会踝-后足评分系统评分：优28例,良5例,可2例,优良率94.29%。结论：在俯卧体位下采用后外侧切口治疗三踝骨折可一次性复位、固定后踝和外踝骨折,联合内侧切口可在一个体位下完成三踝骨折的手术,缩短手术时间,对软组织破坏少,骨折可获得解剖复位,术后踝关节功能恢复佳,可降低因反复翻身而污染术野的概率。Objective： To evaluate the clinical efficacy and safety of posterolateral approach for open reduction and internal fixation （ORIF） of trimalleolar ankle fractures under prone position. Methods： Thirty five patients with trimalleolar fractures were selected and treated surgically by the same group of doctors in our hospital from January 2014 to January 2015, using the posterolateral approach. Plates were placed in the posterior or lateral of fibula when lateral malleolus was dealed with, screws or plates were used to fix the posterior malleolus and medial malleolus was fixed by 2 lag screws. Incision and fracture healing were observed, and the ankle function was evaluated according to the AOFAS. Results： The operation time ranged from 50 rain to 142 minutes, the average time was 90 minutes. The follow-up time ranged from 6months to 18months, the average follow-up time was 15 months. 1 cage appeared local inflammatory response in medial incision after surgery, the symptoms become better after changing fresh dressing, no wounds was infected apparently. 2 case appeared numbness in the lateral dorsum of foot, and numbness disappeared after 6 weeks and 9 weeks respectively. All the 35 patients showed fracture lines were fuzzy in X-ray plain 3 months after the surgery. AOFAS SCORE were excellent in 28 cases, good in 5 cases and moderate in 2 cases, the excellent rate was 94.29 %. Conclusions： Posterolateral approach for open reduction and internal fixation （ORIF） of trimalleolar ankle fractures could take reposition and fixation lateral malleolus and posterior malleolar fracture at the same time, Combing with medial malleolus can also be dealt combing with medial incision under the same position. This approach to treat trimalleolar ankle fractures had less injury to soft tissue and shortens the operation time. Fractures could be obtained anatomic reduction and patients gain better functional recovery. The probability of pollution which was caused by changing position can reduce.

关 键 词：踝关节 三踝骨折 后外侧入路 切开复位 内固定 

分 类 号：R683[医药卫生—骨科学]