探讨内踝、外踝与后踝俯卧位联合入路治疗三踝骨折的临床研究

Discussion on clinical efficacy and discussion of prone position after ankle lateral,posterolateral approach combined with medial joint approach for the treatment of trimalleolar fracture

目的探讨俯卧位踝关节后外侧、内侧联合入路治疗三踝骨折的临床效果。方法选择2013年6月~2014年6月我院收治的52例三踝骨折患者为研究对象,随机将其分为观察组和对照组,每组26例患者。观察组采用俯卧位踝关节后外侧、内侧联合入路固定治疗,对照组采用常规的骨折治疗方法,比较两组的临床疗效。结果观察组患者的手术时间为（93.5±4.6）min,术中出血量为（85.5±10.3）ml,术后住院时间为（11.2±1.1）d,骨折愈合时间为（5.2±0.5）个月,对照组患者的手术时间为（103.5±8.7）min,术中出血量为（105.5±8.6）ml,术后住院时间为（13.4±1.5）d,骨折愈合时间为（5.9±0.8）个月,观察组的手术时间、术中出血量、术后住院时间、骨折愈合时间均显著低于对照组,差异有统计学意义（P〈0.05）。观察组所有患者切口均Ⅰ期愈合,无骨折再移位,无内置物松动,无伤口感染及骨不连;对照组患者均Ⅰ期愈合,2例骨折移位,2例内置物松动,3例伤口感染及骨不连。根据Baird-Jackson评分评价疗效,观察组优10例,良10例,可6例,总优良率为76.9%;对照组优4例,良5例,可17例,总优良率为34.6%,观察组的总优良率显著高于对照组,差异有统计学意义（P〈0.05）。结论采用俯卧位踝关节后外侧、内侧联合入路进行内固定治疗三踝骨折,治疗效果显著,方法简单可靠,值得临床推广应用。

Objective To investigate the clinical efficacy of prone position after ankle lateral,posterolateral approach combined with medial joint approach for the treatment of trimalleolar fracture.Methods 52 cases of patients who were treated for trimalleolar fracture in hour hospital from June 2013 to June 2014 in our hospital were selected as the research object,.They were randomly divided into observation group and the control group.The observation group was used the prone position after ankle lateral,posterolateral approach combined with medial joint approach for treatment,the control group was used conventional fracture for treatment.The clinical curative effect was observed.Results For the obervation group,the mean operative time was（93.5±4.6） minutes,the average amount of bleeding was（85.5±10.3） ml,the average hospitalization time of postoperative was（11.2±1.1） days,the average healing time was（5.2±0.5） months.As for the control group,the average operation time was（103.5 ±8.7） minutes,the average amount of bleeding was（105.5 ±8.6） ml,the averaged postoperative hospitalization time was（13.4 ±1.5） days,the average healing time was（5.9 ±0.8）months.In the observation group,the average operation time,average bleeding volume,postoperative hospitalization time,the average healing time were significantly lower than those in the control group,and there were significant differences（P〈0.05）.There were no fracture displacement,no implant loosening,no wound infection;while the patients of the control group patients were stage Ⅰ healing,2 cases of fracture displacement,2 cases in the locker,3 cases of wound infection and bone.According to Baird Jackson scoring system was used to evaluate the effect,the result showed that, observation group was excellent in 10 cases,good in 10 cases,6 cases,the excellent and good rate was 76.9%;the control group were excellent in 4 cases,good in 5 cases,17 cases,the overall excellent and good rate was 34.6%,the excellent rate of the obervation group was significantly better than that of the control group,and there was a significant difference（P〈0.05）.Conclusion The prone position behind the ankle lateral and medial combined approach internal fixation in the treatment of trimalleolar fracture,the treatment efficacy of it is remarkable,the method is simple and reliable,it is worthy of clinical popularization and application.