后外侧入路在踝关节骨折中的应用

Application and evaluation of posterolateral approach fractures

目的评价后外侧入路在踝关节骨折中的应用价值。方法2005年3月至2007年8月对23例踝关节骨折采用后外侧入路，其中按照Lauge—Hansen分型：旋后外旋型Ⅲ度4例，旋后外旋型Ⅳ度12例，旋前外旋型Ⅳ度7例。所有患者均同时有腓骨远段和后踝的骨折，其中17例存在内踝骨折，2例为单纯三角韧带损伤。同时对后外踝行切开复位内固定，外踝骨折处钢板放置于腓骨远端后侧，后踝骨折直接行螺钉或钢板固定。观察术后伤口愈合、骨折愈合及内固定情况，同时按Olerud和Molander踝关节骨折术后评分系统对踝关节功能进行评估。结果所有患者获得6～23个月（平均15个月）随访。伤口无裂开、坏死，除1例术后10d出现浅表感染，经积极换药及适量抗生素处理后愈合外，其余均愈合良好。l例术后出现腓肠外侧皮神经损伤症状，未做特殊处理，3个月后自行缓解。1例出现症状轻微的腓骨肌腱炎，骨折愈合取出钢板后症状消失。术后4～6个月X线片示骨折均愈合，无内固定松动、断裂。踝关节骨折术后功能评分平均为91分，优良率为95．6％。结论后外侧入路可同时完成后、外踝骨折的治疗，能在直视下对后踝进行有效复位及可靠固定。

Objective To evaluate the posterolateral approach used in the surgical management of displaced lateral and posterior malleolar fractures. Methods From March 2005 to August 2007, 23 patients with displaced lateral and posterior malleolar fractures were treated by open reduction and internal fixation （ORIF） through the posterolateral approach. The posterior anti-glide plate was used to assist the reduction of lateral malleolar fractures, while traditional lateral plates or screws were used for posterior malleolar fractures. Postoperative wound healing, union of fractures and condition of internal fixation were measured and recorded. The Olernd and Molander scoring system was used to evaluate the functional recovery of the ankle joint. Results All the patients were followed up for 6 to 23 （average, 15） months. No dehiscence or necrosis of the wound was found. One patient suffering from superficial infection 10 days after surgery was treated with dehridement and antibiotics. One patient presented with postoperative symptoms of peroneal nerve injury which were relieved naturally 3 months later. One patient presented with mild postoperative symptoms of peroneal tendinitis which subsided ＂after hardware removal following fracture union. The X-rays 4 to 6 months after surgery showed all fractures united without loosening or rupture of the internal fixators. Functional recovery of the ankle joint scored 91 points on average, with an excellent to good rate of 95.6%. Conclusions As the posterolateral approach can be used to treat the displaced lateral and posterior malleolar fractures simultaneously, it provides an alternative for treatment of ankle fractures.