后外侧入路钢板固定后踝骨折的临床研究

Anti-sliding Plates from the Approach of Posterolateral of Ankle Joint for the Fracture of Posterior Malleolus

目的总结踝关节后外侧入路切开复位支持钢板固定后踝骨折的临床疗效，探讨后踝固定的可靠方法。方法回顾性分析河北医科大学第三医院骨科和沧州中西医结合医院骨科，自2005年7月至2009年7月间采用踝关节后外侧入路支持钢板固定后踝骨折的病例资料，总结手术时间、出血量、复位结果、并发症及踝关节功能。结果35例获得随访，平均手术时间1．2h，平均出血量120mL。根据Leeds等X线术后即时评估标准评定，优28例，良6例，差1例，优良率为97．1％。1例患肢麻木酸胀5d后恢复；术后切口均Ⅰ期愈合，无切口渗液、感染及钢板外露者。平均随访31．2个月，骨折全部愈合，平均愈合时间87d，无断钉等并发症发生。按照美国足踝骨科协会推荐的足踝评分系统评分，优（90～100分）21例，良（80～89分）9例，可（70～79分）5例，差（小于69分）0例，优良率为85．7％。结论踝关节后外侧入路治疗后踝骨折复位确实，固定可靠，对经过闭合复位骨折位置欠佳者更为适用，不仅适用于后踝单个大骨块，而且适用于多个骨折块及移位较大者。

Objective To summarize the clinical effect of the fracture of posterior malleolus by Anti-sliding plates from the ankle joint posterolateral approach,to explore indications of this methods. Methods From July 2005 to July 2009. the 35 cases of the fracture of posterior malleolus from the orthopedic department of The 3rd hospital and CangZhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University,treated by Anti-sliding plates from the approach of the posterolateral of ankle joint, summarizes the duration of surgery time,the bleeding and reset results of reduction,complications and ankle function. Results The average surgical time of 35 cases is 1.2 h. Average 120 mL bleeding. According to X ray evaluation standard of Leeds,Optimal 28 cases. good 6 cases, poor 1 case,Excellent 97.1%. 1 case limb numb for 5 days,without incisional drainage, infection and steel exposed. The average time of follow up is 31.2 months, average fracture healing time is 87 d. no broken nailing complications. According to the AOFAS,optimal 21 cases, good 9 cases, can 5 cases, poor 0 case. Excellent 85.7%. Conclusion The excellent reduction and reliable fixiation can be obtained by this methods for the fracture of posterior malleolus. Not only for a single large block,but the several and shift blocks.