后外侧入路钢板固定治疗后踝骨折的临床疗效分析

Clinical efficiency of posterior malleolus fractures by plate fixation via the posterolateral approach

目的探讨后外侧入路钢板固定后踝骨折的手术方法及临床疗效。方法 2008年5月～2012年3月,采用后外侧入路钢板固定治疗后踝骨折37例。根据Lauge-Hansen踝关节骨折分型,旋后外旋型23例,旋前外展型6例,旋前外旋型8例。术后定期门诊随访,观察骨折愈合及踝关节功能情况。结果本组患者手术时间为63～105min,平均82.0min;所有患者均获随访,随访时间13～17个月,平均14.5个月。所有患者切口均Ⅰ期愈合,X线片检查示所有骨折均获骨性愈合,随访期间未见内固定物移位、松动或断裂;末次随访时,踝关节功能根据Phillips踝关节评分标准,本组评分为110～150分,平均141.0分;获优21例、良好11例、一般3例、差2例;优良率为86.5%。结论采用后外侧入路钢板固定治疗后踝骨折,创伤小,手术显露清晰,可直接地精确复位关节面,并进行稳定固定。

Objective To discuss the operative method and clinical effect for posterior malleolus fractures fixed with plate via the posterolateral approach. Methods Between May 2008 to Mar. 2012,37 patients with posterior malleolar fractures were treated, including 25 males and 12 females, aged from 20 to 68 years. Fractures were classified with Iauge - Hansen classification system ： supination-external rotation in 23 cases, pronation-abduction in 6 cases and pronation - external rotation in 8 cases. The patients were followed in outpatient clinic way. The fracture healing and ankle function were observed by the X-ray examinations postoperatively. Results The operative duration ranged from 63 to 105 minutes （mean 82 minutes）. All patients got follow-up visit for at least 13 months （from 13 to 17 months, mean 14. 5 months）. The incisions of all the patients achieved primary healing. Postoperative radiograph showed bone union in all the patients. In the period of follow-up, there was no displacement, loosening or breakage of internal fixation. At the final follow-up, according to Phillips ankle scoring system, the score ranged from 110 to 150,with an average of 141.0. There was excellent in 21 cases,good in 11 cases,fair in 3 cases and poor in 2 cases, with an excellent and good rate of 86.5 %. Conclusion The plate via posterolateral approach is less invasive and has characteristics of good surgical exposure, accurate fracture reduction and stable fixation.