经踝管后内侧入路联合腓骨外侧入路治疗三踝骨折的临床效果观察

Treatment of trimalleolar factures through posteromedial combined with lateral surgical approach

目的评价经踝管后内侧入路联合腓骨外侧入路治疗三踝骨折的临床疗效。方法回顾性分析37例采用经踝管后内侧人路联合腓骨外侧人路治疗三踝骨折患者的临床资料，其中男21例，女16例，年龄35—80岁（平均55．0岁）。记录术后切口感染、骨折不愈合、内固定断裂等并发症，并拍摄踝关节标准的正侧位x线片。采用美国足踝外科协会踝与后足评分系统（AOFAS评分系统）评价术后6个月和1年时的临床疗效，采用Kellgren—Lawrence分级标准评价术后1年创伤性关节炎的发生情况。结果患者均获得至少1年的随访，随访时间12～27个月（平均18．8个月）。无一例患者发生伤口感染、皮瓣坏死、内固定断裂、骨折不愈合等早期并发症。术后6个月和1年的AOFAS评分平均为82．9分和89．7分。根据x线片的Kellgren＆Lawrence影像学分级标准评价，术后1年时4例有不同程度的骨关节炎表现。结论经踝管后内侧入路联合腓骨外侧入路治疗三踝骨折手术操作简便，费用低，并发症少，短期临床疗效满意。

Objective To evaluate the effect of posteromedial combined with lateral surgical approach in treatment of trimalleolar factures. Methods The clinical data of 37 patients with trimalleolar factures underwent open reduction and internal fixation through posteromedial combined with lateral surgical approach were retrospectively ana- lyzed. There were 21 males and 16 females with average age of 55.0 years （ ranged 35 - 80）. Complications such as infection, nonunion, fixation failures were observed. All patients were followed up at 6 months and 12 months after sur- gery and assessed functionally with American Orthopaedic Foot and Ankle Society Scores （AOFAS）. After the 12 month follow up,the patients were also called for a radiological examination. Results Average follow - up time was 18.8 months （12 -27 months）. All cases had no complications such as incision infection, skin necrosis, internal fixator loosening or rupture and bone nonunion. Using AOFAS, the scores were 82.9 and 89.7 respectively at the 6 month and 12 month follow up. The degree of arthrosis was grades I in 2 ankles, Ⅱ in 1 ankle,and Ⅲ in 1 ankle according to Kellgren＆Lawrence. Conclusion Posteromedial combined with lateral surgical approach for the treatment of trimalleolar factures has leaded to an satisfactory clinic outcomes. It is minimally invasive and has less complications and cost.