经腓骨骨折端辅助复位治疗外后踝合并关节面压缩骨折的病例对照研究

Case-control study on reduction for external and posterior malleolar fractures combined with compressive articular surface through tibiafibular fractures region

目的 :比较经腓骨骨折端辅助复位和经跟腱内侧辅助复位结合外后侧内固定治疗外后踝合并关节面压缩骨折的临床疗效。方法:自2012年1月至2015年1月,治疗外后踝合并关节面压缩骨折52例,采用经腓骨骨折段辅助复位内固定治疗24例(A组),男16例,女8例;年龄20~65岁,平均(35.2±6.4)岁;经跟腱内侧入路辅助复位内固定治疗28例(B组),其中男18例,女10例;年龄22~62岁,平均(36.4±4.8)岁。观察并比较两组患者的手术时间、出血量、切口长度、X线暴露次数及并发症发生情况,术后采用美国足踝外科协会踝-足(AOFAS)评分对两组患者的功能进行评价。结果:所有患者均获得随访,A组随访时间13~55个月,平均(27.5±2.5)个月;B组随访时间12~54个月,平均(28.5±2.4)个月。所有患者获得骨性愈合,愈合时间10~16周,平均12周。B组有2例出现切口感染,1例出现螺钉松动;A组无切口感染发生,1例出现螺钉松动。两组手术时间、出血量、X线暴露次数及并发症情况比较差异有统计学意义;两组踝关节AOFAS功能评分比较差异无统计学意义。结论:与经跟腱内侧辅助复位相比,经腓骨骨折端辅助复位治疗外后踝合并关节面压缩骨折具有出血少、手术时间短、X线暴露次数少、踝关节功能恢复好的优点,特别在处理常规入路难以复位的嵌夹的后外侧关节面压缩骨块,优势明显。

Objective：To compare clinical outcomes of external and posterior malleolar fractures associated with compressive articular surface through posteriorlateral incision and posteriormedial incision. Methods：From January 2012 to January 2015,52 patients with external and posterior malleolar fractures associated with compressive articular surface were treated by interfix. Among them,24 patients were treated through posteriourlateral incision,including 16 males and 8 females,aged from 20 to 65 years old with an average of（35.2±6.4）;28 patients were treated through posteromedi and posterior lateral incision,including 18 males and 10 females,aged from 22 to 62 years old with an average of（36.4 ±4.8）. Operation time,blood loss,length of incision,times of X ray exposure and complications between two groups were recorded and compared,AOFAS scores were applied for evaluate clinical outcomes. Results：All patients were followed up,group A were followed up from 13 to55 months with an average of（27.5±2.5） months;group B were followed up from 12 to 54 months with an average of（28.5±2.4） months. All fractures were obtained good reduction,and the healing time ranged from 10 to 16 weeks with an average of 12 weeks. Two patients in group B occurred incision infection,and 1 patient occurred screw loosening; while no incision infection occurred in group A,and 1 patient occurred screw loosening. There were statistical significance in operation time,blood loss,times of X ray exposure and complications between two group;while no significant difference in ankle AOFAS score between two groups. Conclusion：Compared with reduction through achilles tendon,reduction for external and posterior malleolar fractures combined with compressive articular surface through tibiafibular fractures region has advantages of less blood loss,shorter operation time,less times of X ray exposure,good recovery of ankle joint function,especially in treating external and posterior malleolar combined with compressive articular surface which could not obtained good reduction through normal pathway.