不同手术入路与体位在三踝骨折内固定手术中的应用

Internal fixation for trimalleolar fractures by application of different operation approach and position

目的探讨不同手术入路与手术体位内固定治疗三踝骨折的疗效。方法自2007-01—2012-06共收治72例三踝骨折,采用不同手术入路与手术体位行切开复位内固定手术治疗。传统入路配合仰卧位22例,后外侧入路配合俯卧位18例,后外侧入路配合健侧卧位改传统入路配合仰卧位32例。观察术后近期并发症、骨折愈合时间及踝关节背屈、跖屈活动度。采用Olerud-Molander评分系统评定疗效。结果本组均获随访12~36个月。骨折愈合时间12~24周。踝关节活动范围：背屈15°~30°,平均22.8°;跖屈25°~50°,平均41.8°。末次随访时Olerud-Molander评分：优51例,良16例,可5例,优良率93.1%。结论根据三踝骨折不同的情况,采取与之相适应的手术入路与手术体位,可获得满意效果。

Objective To analyze the effectiveness of different operation approach and position in treating trimalleolar fractures. Methods Seventy two cases of trimalleolar fractures were surgically treated from January 2007 to June 2012.Traditional approach with supine position in 22 cases were performed by open reduction and internal fixation, posterolateral approach with prone position in 18 cases, and posterolateral approach with lateral position to traditional approach with supine position in 32 cases. Postoperative complications, fracture healing time, range of motion（ROM） of the ankle joint including dorsiflexion and plantar flexion were recorded. The Olerud and Molander scoring system was used to evaluate the functional recovery of the ankle joint. Results All patients were followed up from 12 to 36 months. All fractures were healed from 12 to24 weeks. The mean ROM of the ankle joint was 22.8°in dorsiflexion（range, 15°to 30°）, was 41.8°in plantar flexion（range, 25°to 50°）. According to the Olerud and Molander scoring system, the results were excellent in 51 cases, good in 16 cases, and fair in 5 cases; and the excellent and good rate was 93.1%. Conclusion Selection of appropriate operation approach and position according to different conditions of trimalleolar fractures can achieve effective treatment.