平卧位前外侧联合后内侧入路结合管型钢板治疗三踝骨折  

Treatment of trimalleolar fractures by anterolateral and posteromedial approach combined tubular plate at supine position

作　　者：朱楠[1] 方望[1] 詹俊锋[1] 周云[1] 荆珏华[1] ZHU Nan;FANG Wang;ZHAN Jun-feng;ZHOU Yun;JING Jue-hua(Department of Orthopaedics,The Second Hospital of Anhui Medical University,Hefei 230601,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院骨科,安徽合肥230601

出　　处：《生物医学工程与临床》2018年第4期404-408,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨平卧位下采用前外侧联合后内侧手术入路结合1/3管形钢板治疗三踝骨折的临床应用价值。方法选择2016年4月至2017年3月安徽医科大学第二附属医院单纯踝部闭合性骨折患者28例,其中男性11例,女性17例;年龄19~68岁,平均年龄43.2岁。按照致伤种类,摔伤19例,车祸伤7例,重物砸伤2例。按照Lauge-Hansen踝关节骨折分型,旋前外旋型Ⅳ度7例,旋后外旋型Ⅳ度21例。均应用前外侧联合后内侧手术入路结合1/3管形钢板,在平卧位下行三踝骨折的切开复位内固定手术。应用美国足踝外科协会(AOFAS)踝-后足评分标准及视觉模拟量表(VAS)疼痛评分标准进行术后临床效果评估。结果手术时间58~75 min,平均手术时间67 min。术中出血量25~45 mL,平均出血量35 mL。28例患者均获得随访,随访时间5~18个月,平均随访时间11个月。AOFAS评分85.8分(67~97分);优8例,良16例,中4例,优良率86%。VAS评分1.6分(0~3分)。3例患者术后出现切口愈合不良,但程度较轻,经积极换药处理后愈合良好,无深部感染发生。结论平卧位下采用前外侧联合后内侧手术入路结合1/3管形钢板治疗三踝骨折,手术操作简便、节省手术时间、固定可靠、手术效果满意,具有很好的临床应用价值。Objective To investigate the clinical value of trimalleolar fractures through anterolateral and posteromedial approach combined 1/3 tubular plate at supine position. Methods From April 2016 to March 2017, 28 patients with closed zygomatic fractures were enrolled, which included 11 males and 17 females, aged 19-68 years old with mean age of 43.2 years old. According to types of injury, 19 cases of falls, 7 of automobile accident injuries, 2 of heavy injuries. In accordance with Lauge-Hansen ankle fracture classification, 7 cases of external rotation type Ⅳ and 21 of supination external rotation type Ⅳ.All of them were treated with anterolateral combined posteromedial surgical approach combined with 1/3 tubular plate, and open reduction with internal fixation of three-sacral fracture in supine position. The postoperative clinical outcomes were evaluated using the American Foot Pediatric Surgery Association（AOFAS） criteria for posterior-foot scores and the visual analogue scale（VAS） pain score criteria. Results Operation time was 67 minutes（58-75 minutes）. The amount of blood lost was 35 m L（25-45 m L）. All 28 patients were followed up for 5-18 months with mean follow-up of 11 months. AOFAS score was 85.8（67-97）; excellent in 8 cases, good in 16 and moderate in 4, the excellent rate was 86 %. The VAS score was 1.6（0-3）. Three cases showed mild postoperative incisions that healed poorly. After active dressing changes, incisions healed well without deep infection. Conclusion It is demonstrated that trimalleolar fractures by anterolateral and posteromedial approach combined 1/3 tubular plate at supine position has good clinical application value, with advantages of simple, time saving, reliable and satisfactory effects.

关 键 词：三踝骨折 闭合性骨折 踝损伤 骨折固定术 内 管型钢板 

分 类 号：R681.8[医药卫生—骨科学]