两种手术入路治疗外踝骨折的对比

Comparison of two different surgical approaches for the treatment of lateral malleolus fractures

目的:对比分析外侧入路与后外侧入路治疗旋后外旋型Ⅳ度踝关节骨折的疗效。方法:回顾性分析2010年1月至2014年1月收集的80例旋后外旋型Ⅳ度踝关节骨折病例,均为闭合性骨折。其中48例行外侧入路钢板螺钉固定;32例行后外侧入路钢板螺钉固定。对2组患者术中情况、术后第3天疼痛评分、骨折愈合时间、临床疗效及并发症进行对比分析。结果:2组患者在手术时间、术中失血量及术后第3天疼痛评分等方面比较,差异均无统计学意义(均P>0.05)。外侧入路组骨折愈合时间为(16.6±2.2)周,与后外侧入路组的(15.4±3.0)周差异无统计学意义(P>0.05);后外侧入路组踝关节功能评分为(44.3±1.5)分,优于外侧入路组的(41.2±1.0)分,步态异常发生率低于外侧入路组。后外侧入路组有3例出现并发症,少于外侧入路组的6例,差异有统计学意义(P<0.05)。结论:外侧入路对外踝骨折有一定的优越性,而后外侧入路对旋后外旋型Ⅳ度踝关节骨折应用更有优势。

Objective： To compare the outcome of two fixed methods for the treatment of anklebone fractures（stage Ⅳ）. Methods： The clinical data of 80 patients with anklebone fractures were collected between Jan 2010 to Jan 2014. Forty-eight patients were treated with lateral approaches. Thirty-two patients were treated with posterolateral approaches. The indexs of perioperation, pain score at 3 days postoperative, bone union time, the clinical outcomes and postoperative complications were statistically compared. Results： There were no statistical significance on operation time, perioperative blood loss, bone union time and pain score at 3 days postoperative（P〈0.05）. The function of ankle score in the postoperative group was significantly higher than that in the lateral group [（44.3±1.5） vs（41.2±1.0）], meanwhile, the incidence of abnormal gait was lower. There were 3 cases of postoperative complications in the postoperative group, it was significantly less than the 6 cases of the lateral group. Conclusion： The lateral approach shows superiority in treatment of anklebone fractures, however, the posterolateral approach has the advantages in stage Ⅳ.