“前向后”螺钉和“后向前”螺钉固定治疗HaraguchiⅠ型后踝骨折的疗效比较  

Comparison of the effects of anteroposterior and posteroanterior screws fixation techniques for the surgical management of Haraguchi typeⅠposterior malleolar fractures

作　　者：夏胜利 马梓元 高峰 郭胜洋 王彬 周小小[1] 付备刚 王明辉[1] 蔡攀 刘晓庆 Xia Shengli;Ma Ziyuan;Gao Feng;Guo Shengyang;Wang Bin;Zhou Xiaoxiao;Fu Beigang;Wang Minghui;Cai Pan;Liu Xiaoqing(Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital,Shanghai,201318,China)

机构地区：[1]上海健康医学院附属周浦医院,上海201318

出　　处：《生物骨科材料与临床研究》2021年第3期54-58,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：上海市浦东新区卫生健康委员会领先人才培养计划资助项目(PWR12018-09);上海市浦东新区卫计委特色学科(PWYts2018-02);上海市卫健委重点专科(ZK2019B05)。

摘　　要：目的比较“前向后”螺钉和“后向前”螺钉固定治疗三踝骨折中的HaraguchiⅠ型后踝骨折的疗效。方法回顾性分析2014年1月~2019年7月收治的83例伴有HaraguchiⅠ型后踝骨折的三踝骨折。其中,男33例,女50例;年龄18~77岁,平均47.5岁,均为单侧骨折,旋后外旋型Ⅳ度61例及旋前外旋型Ⅳ度22例;后踝骨折块面积占比平均19.8%(15%~32%);其中38例采用间接复位由“前向后”螺钉内固定后踝骨折,45例采用后外侧入路直接复位螺钉内固定后踝骨折。比较两组手术时间、后踝骨折复位质量及临床功能疗效。结果所有患者术后获得平均15.6个月随访(6~26个月),骨折均获得愈合。“前向后”组手术时间明显少于“后向前”组(P<0.05)。在关节面复位影像学评价中,“前向后”组中优13例(34.2%)、良19例(50.0%)及差6例(15.8%);“后向前”组中优26例(57.7%)、良16例(35.6%)及差3例(6.7%),两组间差异有统计学意义(P<0.05)。末次随访AOFAS踝与后足评分:“前向后”组(83.05±7.85)分,“后向前”组(87.84±7.22)分,两组间差异有统计学意义(P<0.05)。结论与“前向后”间接复位螺钉固定HaraguchiⅠ型后踝骨折相比,通过后外侧入路直接复位螺钉内固定可以获得更好的骨折复位质量及临床功能疗效。Objective To compare the effects of Haraguchi type I posterior malleolar fractures fixed by anteroposterior screws or posteroanterior screws.Methods A retrospective analysis was performed in 83 cases of trimalleolar fracture with Haraguchi type I posterior malleolus fractures from January 2014 to July 2019,including 33 males and 50 females aged from 18 to 77 years old,with an average of 47.5 years old,all of which were unilateral fractures,including 61 cases of pronation-external rotation typeⅣand 22 cases of supination-external rotation typeⅣ,with an average fractures area of 19.8%of the total distal tibia area.Indirect reduction technique with anteroposterior screws fixation was applied in 38 posterior malleolus fractures,while direct reduction with screw internal fixation through posterolateral approach was applied in 45 posterior malleolus fractures.The operation time,reduction quality and clinical functional effects of ankle fractures were compared between the two groups.Results All patients were followed up for an average of 15.6months(6-26 months),and the fractures were healed.The operation time in the anteroposterior was significantly shorter than that in the posteroanterior group(P<0.05).In the radiological evaluation of reduction of articular surface,excellent fracture reduction was observed in 13 cases(34.2%),good in 19 cases(50.0%)and poor in 6 cases(15.8%)in the anteroposterior group,while excellent in 26 cases(57.7%),good in 16 cases(35.6%)and poor in 3 cases(6.7%)in the posteroanterior group.The difference between the two groups was statistically significant(P<0.05).In the last follow-up,AOFAS ankle and hind foot scores were(83.05±7.85)in the anterior posterior group and(87.84±7.22)in the posterior anterior group,with significant difference between the two groups(P<0.05).Conclusion Compared with indirect reduction and anterior posterior screw fixation for Haraguchi type I posterior malleolus fracture,direct reduction with posterior anterior screw fixation via posterolateral approach can achie

关 键 词：螺钉内固定 HaraguchiⅠ型 后踝骨折 

分 类 号：R683.42[医药卫生—骨科学]