后踝骨折手术复位内固定的疗效分析

Posterolateral approach for open reduction and internal fixation of posterior malleolar fractures

背景：随着对踝关节损伤的进一步认识,后踝骨折逐渐被临床医师所重视,越来越多的后踝骨折采用手术治疗。目的：评价手术复位内固定治疗后踝骨折的手术指征、方法及疗效。方法：回顾性分析2008年4月至2012年5月采用后外侧入路支撑接骨板或（和）空心拉力螺钉治疗并获完整随访的37例后踝骨折患者的临床资料,男23例,女14例;年龄21~68岁,平均（43±1.3）岁。根据Lauge-Hansen分型：旋后外旋Ⅲ度14例,Ⅳ度10例;旋前外旋Ⅳ度13例。全部患者均由同一组骨科医师进行择期手术,采用后外侧入路行后踝及外踝骨折内固定,有内踝骨折者联合内侧入路行内踝内固定。术后随访,观察骨折愈合情况、内固定稳定情况和踝关节功能情况。结果：手术时间为65~120 min,平均（85±3）min;住院时间为5~14 d,平均（9.3±0.8）d。患者切口均Ⅰ期愈合。随访时间为13~36个月,平均（24.7±1.1）个月,无一例发生畸形愈合、骨折再移位及内固定失败。骨折愈合时间为2~4个月,平均（2.9±0.4）个月。根据美国矫形足踝协会（AOFAS）踝-后足评分标准进行功能评估,优20例,良13例,中4例,优良率为89%。结论：手术复位内固定治疗后踝骨折可获得解剖复位和坚强固定,早期功能锻炼利于患者获得良好的功能结果。

Background： With the intensive understanding of ankle injury, posterior malleolar fractures were valued by clinicians gradu- ally, and more and more posterior malleolar fractures were treated by operation. Objective： To evaluate the indication of surgical treatment, operative procedure and clinical outcomes of open reduction and internal fixation for posterior malleolar fractures. Methods： Between April 2008 and May 2012, 37 patients with posterior malleolus fractures were treated with open reduc- tion and internal fixation by posterolateral approach and followed up. There were 23 males and 14 females with an average age of （43±1.3） years （range, 21-68 years）. According to Lauge-Hansen classification system, 14 cases and 10 cases were rated as supination-external rotation type Ⅱ and type Ⅳ respectively, and 13 cases as pronation-external rotation type IV. All the patients underwent selective operation by the same work team. The status of healing and internal fixation and ankle joint function were observed during follow-up. Results： The average operation time was （85＋3） min （range, 60-120 min）, and postoperative hospital stay was （9.3±0.8） d （range, 5-14 d）. All the patients were followed up for （24.7± 1.1） months （range, 13-36 months）. Primary healing was achieved in all incisions. No malunion, re-displacement or internal fixation failure occurred. The healing time of fractures was （2.9±0.4） months on average （range, 2-4 months）. The results of American Orthopaedic Foot and Ankle Society （AO- FAS） ankle and hindfoot score were excellent in 20 cases, good in 13, and fair in 4 with an excellent and good rate of 89%. Conclusions： Reduction and fixation can maintain well after open reduction and internal fixation for posterior malleolar frac- ture. Early weight bearing is helpful for recovery.