后外侧入路在老年性踝关节骨折中的应用

The application of posterolateral approach in ankle fractures of the elderly

[目的]评价后外侧入路在老年踝关节骨折中的临床应用。[方法]2005年3月～2007年8月对13例老年踝关节骨折采取后外侧入路行外后踝骨折切开复位内固定,同一切口中外踝骨折钢板内固定放置于腓骨远端后侧、后踝骨折行螺钉或钢板固定。观察术后伤口愈合、骨折恢复及内固定情况,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]13例均获随访,随访时间6～23个月,平均15个月。伤口无裂开、坏死,1例出现症状不甚严重的腓骨肌腱炎,骨折愈合后取出钢板后症状消失。术后4～6个月X线片显示骨折均愈合,无内固定松动、断裂。踝关节骨折术后功能评分平均为91分,其中优9例,良3例,可1例,优良率为92.3%。[结论]后外侧入路能同时完成后外踝骨折的治疗,可减少老年患者的手术创伤、创面感染及坏死等并发症,对伴骨质疏松老年患者的外踝骨折能进行牢靠安全固定。

[Objective] To evaluate the clinical application of the posterolateral approach for surgical management of displaced lateral and posterior malleolar fractures of the elderly.[Method]From March 2005 to August 2007,13 patients with displaced lateral and posterior malleolar fractures were treated by open reduction and internal fixation（ORIF） through posterolateral approach.Posterior antiglide plate was assisted in the reduction of lateral malleolar fractues,whereas traditional lateral plate or screws for posterior malleolar fractures.Postoperative wound healing,union of fractures and situation of internal fixations were measured and recorded.System for symptoms after ankle fracture were described and validated.Olerud and Molander was used to measure the outcome.[Result]All the patients were followed up for 6 to 23（average,15） months.No dehiscence and necrosis of wound were found.The pain in one patient with peroneal tendon lesion relieved after hardware removal.All fracture were united 4-6 months after surgery by X-ray scanning.No loss and rupture of internal fixations were found.According to evaluation criteria,the mean ankle score were 91 points,9 patients had excellent result,3 good,and 1 fair.The excellent and good results rate was 92.3%.[Conclusion]The posterolateral approach can treat the fractures of displaced lateral and posterior malleolar fractures simultaneouly.This approach can reduce surgical hurt and counter the disadvantages of wound necrosis and infection for the old patients and especially bring reliable and safe internal fixation for the lateral malleolar fractures of old patients with osteoporotics.