后外侧入路治疗后踝骨折的疗效分析

Posterolateral Approach for Treatment of The Ankle with Posterior Malleolus Fracture

目的探讨后外侧入路治疗后踝骨折的临床疗效。方法随访分析2007年1月至2012年6月运用后外侧入路治疗的54例移位大于25％的后踝骨折，按Lauge—Hansen分类，旋后外旋型Ⅲ度2例，旋后外旋型Ⅳ度40例，旋前外旋型Ⅳ度12例。后踝骨折采用螺钉或支撑钢板固定。外踝骨折采用钢板固定，52例合并内踝骨折用螺钉固定。结果本组病例均获随访，时间6～36个月，平均（15．2±6．0）个月。骨折愈合时间12～24周，平均（14．5±3．6）周。2例患者出现腓肠神经损伤症状，口服营养神经药物治疗，3个月后症状消失。踝关节活动范围：背屈15°～30°，平均（20．5±4．6）。；跖屈25°-50°，平均（38．7±7．9）°。根据Olerud—Molander评分系统进行疗效评价，优32例，良18例，可4例，优良率92．6％。结论后外侧人路是治疗后踝骨折的一个有效入路。

Objective To evaluate the effectiveness of the posterolateral approach for treatment of the ankle with posterior malleolus fracture. Methods A total of 54 patients with ankle fractures involving more than 25% posterior malleolus were treated through the posterolateral approach from January 2007 to June 2012. The fractures were classified according to Lauge - Hansen classification,2 with Lauge- Hansen SE3 ankle fractures ,40 with Lauge -Hansen SE4 and 12 with Lauge -Hansen PE4. Posteior malleolus was fixed with screws or a buttress plate. Lateral malleolus was fixed with the plate and medial malleo- 1us （52 cases） was fixed with screws. Results All patients were followed up from 6 to 36 months （ average, 15.2 ± 6.0） , the bone healing was obtained from 12 to 24 weeks （average, 14.5 ± 3.6 ）. 2 patients developed syndromes of injury of the sural nerve, with total recovery 3 months later with oral drug therapy. The dorsiflexion of the ankle was from 1 5° to 3 0 ° （ average , 20.5 ± 4.6） and the plantar flexion was from 25° to 50° （ average, 38.7 ± 7.9 ）. According to 01erud - Molander scoring sys- tem ,32 were excellent, 18 were good and 4 were fair, the excellent and good rate was 92.6%. Conclusion The posterolateral approach is a useful approach for treatment of the ankle with posterior malleolus fracture.