踝损伤的后踝骨折块由前向后空心螺钉固定  

Anterior-posterior placement of cannulated screws for internal fixation of posterior malleolus fracture fragment in ankle injuries

作　　者：高懋峰[1] 王治栋[1] 朱若夫[1] 施卫东[1] 干旻峰[1] GAO Mao-feng;WANG Zhi-dong;ZHU Ruo-fu;SHI Wei-dong;GAN Min-feng(Department of Orthopedics,The First Affiliated Hospital,Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国矫形外科杂志》2022年第24期2281-2284,共4页Orthopedic Journal of China

摘　　要：[目的]探讨由前向后空心加压螺钉内固定治疗后踝骨折块的临床疗效。[方法] 2015年6月—2020年9月,对53例患者采用由前向后空心拉力螺钉内固定踝损伤的后踝骨折块,其中男24例,女29例。评价临床及影像结果。[结果]本组患者均顺利完成手术,手术时间平均(87.23±9.50) min,术中失血量平均(105.25±21.60) ml。患者恢复完全负重活动时间为(2.08±0.78)个月。随平均随访(13.57±4.08)个月的时间推移,VAS评分显著减少(P<0.05),而AOFAS评分,以及踝背伸-跖屈ROM显著增加(P<0.05)。影像方面,术后影像显示骨折复位满意,关节面移位距离较术前明显减小(P<0.05),根据Burwell-Charnley评级,47例解剖复位,6例复位可。至末次随访时,所有患者骨折愈合,关节退变Kellgren-Lawrence评级0级45例,1级5例,2级3例。[结论]由前向后空心拉力螺钉可牢靠固定后踝骨折块,相对手术创伤小,有利于术后恢复。[Objective] To explore the clinical outcomes of anterior-posterior placement of cannulated lag screw for internal fixation of posterior malleolus fracture fragment in ankle injuries. [Methods] From June 2015 to September 2020, a total of 53 patients, including 24males and 29 females, received anterior-posterior placement of cannulated lag screw for internal fixation of posterior malleolus fracture fragment complicated in ankle injuries in our hospital. The clinical and imaging results were evaluated. [Results] All the patients had operation performed smoothly with operation time of(87.23±9.50) min, and intraoperative blood loss of(105.25±21.60) ml, and then resumed full weight-bearing activity in(2.08±0.78) months on an average postoperatively. As time went during the follow up lasted for a mean of(13.57±4.08) months, the VAS scores significantly decreased(P<0.05), while AOFAS scores and ankle dorsal extension-plantar flexion range of motion(ROM) significantly increased(P<0.05). Radiographically, postoperative images showed satisfactory fracture reduction achieved in all the patients, with significantly declined displacement distance of articular surface compared with that before surgery(P<0.05). According to Burwell-Charnley criteria, 47 patients were marked as anatomic fracture reduction, while the remaining 6 patients as acceptable reduction. By the time of last follow-up, all patients got fracture union with the joint degeneration of grade 0 in 45 cases, grade 1 in 5 cases,and grade 2 in 3 cases in term of Kellgren-Lawrence classification. [Conclusion] This anterior and posterior placement of cannulated screws does firmly fix the posterior malleolus fracture fragment in ankle injuries, which minimizes the iatrogenic trauma and is beneficial to postoperative recovery.

关 键 词：足踝 后踝骨折 空心钉 内固定 

分 类 号：R683.42[医药卫生—骨科学]