后外侧入路两种内固定治疗后踝骨折的疗效比较

Clinical effect comparison of two internal fixation methods for the posterior malleolus fractures through posterolateral approach

目的比较后外侧入路空心螺钉和支撑钢板两种内固定治疗后踝骨折的疗效。方法将46例后踝骨折患者采用后外侧入路直接显露复位后踝,分别采用空心螺钉(22例)和支撑钢板(24例)固定。比较两组患者术后并发症情况及踝关节评分情况。结果空心螺钉组患者切口均一期愈合;支撑钢板组1例术后出现切口感染,给予清创、闭式持续冲洗2周后切口愈合。两组患者均获得12个月随访。支撑钢板组和空心螺钉组术后各有1例出现腓骨后侧轻度疼痛不适,注意休息并外用扶他林软膏后疼痛缓解,支撑钢板组1例取出钢板后不适消失。两组均未出现内固定松动、断裂、骨折再移位等情况。术后12个月踝-后足AOFAS评分:支撑钢板组为48.4~96.3(88.1±2.5)分,优良率为23/24;空心螺钉组为45.5~95.5(88.5±3.0)分,优良率为21/22。两组AOFAS评分及优良率比较差异无统计学意义(P>0.05)。结论后外侧入路直接复位采用空心螺钉固定和支撑钢板固定均能获得满意的临床疗效,而空心螺钉固定创伤更小且便于取出。

Objective To compare the clinical effect of the treatment of posterior malleolus fractures with cannulated screws and support plate through posterolateral approach. Methods The 46 cases with posterior malleolus fractures were treated with surgery via posterolateral approach. The posterolateral approach was used to expose and reduce the posterior malleolus. The support plate fixation group had 24 cases, cannulated screw fixation group had 22 cases. The postoperative complications and ankle scores were recorded. Results Cannulated screw group： all incisions were primarily healed. In the support plate group： 1 case of incision infection occurred, and was healed after debridement and closed continuous flush for 2 weeks. All cases were received 12 months of follow-up. One case in each group had mild pain in the back of the fibula and the pain relieved after rest and used of voltaren ointment, eventually disap- peared after the removal of the plate. There were no internal fixation loosening, fracture displacement and so on in the two groups. After 12 months, the patients＇ excellent-good rate was 23/24 in the support plate group and was 21/22 in the cannulated screw group. The AOFAS scores were 48.4 - 96. 3 （ 88.1 ± 2. 5 ） points in support plate group and 45.5 -95.5（88. 5 ±3.0） points in the cannulated screw group. Two groups of above data had no significant differ- ence （ P 〉 O. 05 ）. Conclusions The posterolateral approach with prone postition is safe and effective to treat poste- rior malleolar fractures. Both fixation methods with cannulated screw and support plate can obtain satisfactory clinical efficacy. Cannulated screw is easier to be removed than support plate with less trauma.