改良后内侧入路锁定支撑钢板内固定治疗Bartoníček Ⅲ型后踝骨折  

Surgical treatment of Bartoníček typeⅢposterior malleolar fractures with anatomic locking plate fixation through a modified posteromedial approach

作　　者：王勇 王强 张盘军 朱和平 Wang Yong;Wang Qiang;Zhang Panjun;Zhu Heping(Department of Orthopedics,the Affiliated Yixing Hospital of Jiangsu University,Yixing 214200,China)

机构地区：[1]江苏大学附属宜兴医院骨科,宜兴214200

出　　处：《中华实验外科杂志》2024年第11期2628-2631,共4页Chinese Journal of Experimental Surgery

基　　金：无锡市第二届双百中青年医疗卫生拔尖人才项目(BJ2023106)。

摘　　要：目的:探讨采取改良后内侧入路锁定支撑钢板内固定治疗Bartoní?ekⅢ型后踝骨折的临床疗效。方法:回顾性分析2019年1月至2023年10月期间宜兴市人民医院收治的20例后踝骨折患者的临床资料,男9例,女11例;年龄26~76岁(49.3±12.3)岁。按照Bartoní?ek分型均为Ⅲ型。均采取改良后内侧入路行切开复位锁定支撑钢板固定后踝骨折。术后采用Burwell-Charnley标准评价骨折复位质量,末次随访时采用美国足踝外科协会(AOFAS)踝与后足评分标准和疼痛视觉模拟评分(VAS)评价踝关节功能,采取Domsic分级标准评估踝关节创伤性关节炎。计量资料以均数±标准差(x±s)表示,计数资料以例(%)表示。结果:所有患者切口均Ⅰ期愈合,患者均获得随访,随访时间12~36个月(15.5±5.4)个月。术后Burwell-Charnley骨折复位评价标准,解剖复位18例,一般复位2例。骨折均愈合,愈合时间12~24周(12.7±3.3)周。末次随访时AOFAS踝与后足评分71~100分(88.9±7.3)分,其中优13例,良5例,可2例,优良率为90%(18/20);VAS评分为0~3分(1.1±1.1)分。4例发生创伤性关节炎,根据Domsic分级:Ⅰ级3例,Ⅱ级1例。随访期间无一例发生感染、骨折不愈合和内固定失效。结论:对于Bartoní?ekⅢ型后踝骨折,采取改良后内侧入路结合锁定钢板支撑固定具有可以同时暴露和复位后内侧和后外侧骨块、复位准确和固定牢靠等优点,可取得较满意疗效。Objective To evaluate clinical and radiological outcomes of Bartoníček typeⅢposterior malleolar fractures that were fixed with a posterior locking plate by the modified posteromedial approach.Methods The study enrolled 20 patients of Bartoníček typeⅢposterior malleolar fractures treated from January 2019 to October 2023 in Yixing People’s Hospital.There were 9 males and 11 females,aged 26-76 years(49.3±12.3)years.All underwent open reduction and internal fixation via the modified posteromedial approach with an anatomical locking compression plate.Postoperatively,the reduction quality of the joint surface was evaluated by Burwell-Charnley’s radiological evaluation system.Clinical outcomes were evaluated by the American orthopaedic foot and ankle society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS).Posttraumatic arthritis and objectively quantified was assessed using the Domsic grading scale.The quantitative data conforming to normal distribution was expressed as mean±standard deviation(x±s),and categorical data was expressed as number of cases.ResultsThe incision healed in all patients.All patients were followed up for 12-36 months(15.5±5.4)months.According to the Burwell-Charnley radiological criteria,anatomical reduction was achieved in 18 cases and good in 2.The fracture healing time ranged from 12-24 weeks(12.7±3.3)weeks.At the last follow-up,the AOFAS ankle-hindfoot score ranged 71 to 100 points(88.9±7.3)points.Excellent results were found in 13 patients,good in 5 and fair in 2,with the excellent-good rate of 90%(18/20).The VAS score ranged from 0 to 3 points(1.1±1.1)points.4 patients had radiographic evidence of posttraumatic ankle arthritis.According to the Domsic grading scale criteria,there were gradeⅠin 3 cases andⅡin 1 case.There were no infection,nonunion and implant failure.Conclusion The modified posteromedial approach with distal locking plate internal fixation for Bartoníček typeⅢposterior malleolar fractures can result in simultaneous exposure and reduction

关 键 词：后内侧入路 锁定钢板 后踝骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]