后外侧入路联合内侧入路内固定治疗三踝骨折

The posterolateral approach combined with medial approach fixation for the treatment of trimalleolar fracture

目的：探讨经后外侧入路联合内侧入路行内固定手术治疗三踝骨折的疗效。方法采用后外侧入路联合内侧入路治疗23例三踝骨折患者。根据Lauge-Hansen踝关节骨折分型：旋后外旋型15例,旋前外展型4例,旋前外旋型4例。术后定期门诊随访。结果手术时间45∽85（60±15）min,术中失血量50∽100（71±7．2）ml。2例失访,21例获得随访,时间15∽24个月。随访患者骨折均愈合,步态正常,无需借助辅助工具。末次随访时根据美国矫形足踝协会（ AOFAS）踝与后足评分标准进行功能评估,优15例,良4例,中2例。结论采用后外侧入路联合内侧入路治疗三踝骨折入路安全简便,显露清楚,可直接精确复位关节面,同时可进行稳定的固定。

Objective To discuss the efficacy of the surgical treatment for trimalleolar fracture by posterolateral ap-proach combined with medial approach fixation. Methods 23 patients of trimalleolar fracture were treated by pos-terolateral approach combined with medial approach. According to Lauge-Hansen classification of ankle fractures：su-pination-external rotation type 15 cases, pronation and abduction type 4 cases, pronation-external rotation type 4 ca-ses. Regular follow-up after operation. Results The operation time was 45∽85 （60 ± 15） min. Introperative blood loss was 50∽100（71 ± 7. 2）ml. 2 patients were lost to follow-up, 21 cases were followed up for 15∽24 months. All the fractures were healed. Normal gait, without the aid of auxiliary tools were obtained. At the last follow-up, accord-ing to the American Orthopaedic Foot and Ankle Society （ AOFAS） ankle and hindfoot score standard functional as-sessment, the results were excellent in 15 cases, good in 4, fair in 2. Conclusions The surgical treatment for tri-malleolar fracture by posterolateral approach combined with medial approach has advantages of safe and convenient approach, revealing clear,accurate reduction of the articular surface can be used directly, and can be stable fixing.