后外侧入路手术治疗Maisonneuve损伤并后踝骨折

Posterolateral approach for Maisonneuve injury associated with posterior maUeolus fracture

目的探讨后外侧入路手术治疗Maisonneuve损伤并后踝骨折的疗效。方法对2008年1月至2015年6月收治的27例Maisonneuve损伤并后踝骨折患者资料进行回顾性分析，男18例，女9例；年龄20一60岁，平均40．1岁；所有患者采用后外侧入路直视下同时行后踝、下胫腓切开复位内固定，后踝骨折行螺钉或钢板固定，下胫腓联合采用皮质骨螺钉固定。末次随访时采用Baird．Jackson踝关节功能评分系统进行评估。结果所有患者术后获8—30个月（平均18个月）随访，未出现感染、坏死、裂开。无骨折再移位，无内置物松动，所有骨折均获骨性愈合。末次随访时踝关节骨折功能评分优良率为92．6％。结论采用后外侧入路治疗Maisonneuve损伤并后踝骨折显露清晰，可直接精确复位骨折、稳定固定及早期功能锻炼。

Objective To investigate the surgical treatment of Maisonneuve injury associated with posterior malleolus fracture under direct visualization via the posterolateral approach. Methods Between January 2008 and June 2015, 27 patients with Maisonneuve injury associated with posterior malleolus fracture were treated at our department. They were 18 men and 9 women, aged from 20 to 60 years （average, 40. 1 years）. All fractures and syndesmoses received open reduction under direct visualization and internal fixation via the posterolateral approach. The posterior malleolus fractures were fixed with screws or plate and the syndesmoses fixed using cortical bone screws. Functional results were evaluated using the Baird-Jackson ankle scoring system. Results The patients were followed up for 8 to 30 months （average, 18 months） . No wound infection, necrosis, dehiscence, lose of reduction or implant failure was found during follow-up visits. All cases got bony union at the last visit. The excellent and good rate was 92. 6%. Conclusion Since the posterolateral approach allows good access to the Maisonneuve injury and posterior malleolus fracture under direct visualization, it facilitates accurate direct fracture reduction, stable fixation and early exercise.