改良前外侧入路与传统术式入路治疗胫腓骨远端骨折的病例对照研究

Case control study on treatment of distal tibiofibula fractures with modified anterolateral or traditional approach

目的：比较改良前外侧入路与传统术式入路治疗胫腓骨远端骨折的临床疗效。方法：自2009年9月至2012年12月,分别采用改良前外侧入路（改良组）与传统联合入路胫骨前内侧钢板内固定（传统组）治疗45例胫腓骨远端骨折患者。根据Ruedi-Allgower分型：Ⅰ型12例、Ⅱ型26例、Ⅲ型7例。其中改良组23例,男16例,女7例;年龄23~47岁,平均（36.3±7.2）岁。传统组22例,男14例,女8例;年龄25~45岁,平均（33.8±6.4）岁。治疗后比较两组患者的手术时间、术中出血量、切口并发症,并采用踝关节功能AOFAS评分对术后疗效进行评价。结果：45例均获得随访,时间6~36个月,平均21.7个月。传统组手术时间（74.7±9.9）min、术中出血量（94.4±10.4）ml与改良组手术时间（73.7±10.0）min、术中出血量（100.8±12.1）ml比较差异无统计学意义（P〉0.05）;改良组切口术后并发症优于传统组（χ2=4.078,P〈0.05）;改良组术后AOFAS评分（86.1±9.4）优于传统组（72.7±13.9）,两组比较差异有统计学意义（t=3.787,P〈0.05）。结论：改良前外侧入路治疗胫腓骨远端骨折具有术后功能恢复好、并发症较少的优点,可作为临床治疗的选择之一。

Objective：To explore therapeutic effects of modified anterolateral approach and traditional approach in treating distal tibiofibula fractures. Methods：From September 2009 to December 2012,45 patients with distal tibiofibula fractures were performed reduction and interal fixation with modified anterolateral and traditional approaches. According to Ruedi-All- gower classification, 12 cases were type I ,26 cases were type ]~ ,7 cases were type m. Among 45 patients,there were 16 males and 7 females with an average age of （36.3＋7.2） years old （ranged from 23 to 47） years old in advanced group;while there were 14 males and 8 females with an average of （33.8±6.4） years old （ranged from 25 to 45） in tradtional group. Operation time, blood loss, complications of incision were compared, and AOFAS scores were evaluated. Results：All patients were followed up from 6 to 36 months with an average of 21.7 months. In traditional group, operation time was （74.7 ±9.9） rain, blood loss was（94.4±10.4） ml,and（73.7±10.0） rain, （ 100.8±12.1 ） ml in advanced group ,there was no significant meaning between two groups （P〉0.05） ;complications of insicion of advanced group was better than that of traditional group （）（2=4.078,P〈0.05） ; AOFAS score in advanced group （86.1 ~9.4） was better than that of traditional group, and had significant meaning （t=3.787, P〈 0.05 ）. Conclusion：Modified anterolateral group, which has advantages of rapid recovery, less complications, is a good choice for closed distal tibiofibula fractures.