后外侧入路内固定治疗后踝骨折的疗效

The efficacy of posterior malleolus fractures treated by internal fixation via the posterolateral approach

目的探讨后外侧入路手术治疗后踝骨折的内固定选择及疗效。方法采用后外侧入路手术治疗62例后踝骨折患者,根据骨折块大小、形态及移位的方向选择内固定。术后按临床和影像学检查、AOFAS踝-后足功能评分评价手术疗效。结果患者均获得随访,时间8～30个月。骨折均愈合。末次随访时,AOFAS评分89.4分±3.5分,其中优33例,良27例,可2例;踝关节活动度背伸为7°～18°,跖屈26°～47°。术后2例Meta钢板固定的患者出现足趾屈曲挛缩,6例患者踝关节活动时有不适感(其中Meta钢板固定3例,1/3管型固定3例)。结论在后踝骨折的手术治疗中,采用后外侧入路,根据骨折块大小和形态、骨折线类型、软组织情况、骨质特点及内固定特性等方面选择合适的内固定,可以获得良好疗效。

Objective To investigate the selection of internal fixation and clinical effect of posterior malleolus fractures treated with the posterolateral approach. Methods The 62 patients with posterior malleolus fracture treated via the posterolateral approach,internal fixation were selected according to the size,shape and displacement of the fracture block. The clinical results were evaluated based on clinical examination,radiographic evaluation and the AOFAS ankle-hindfoot score. Results All patients were followed up for 8 ～ 30 months after operation. Fractures were healed. At the last follow-up,the postoperative AOFAS score was（ 89. 4 ± 3. 5） points,the result was excellent in 33 cases,good in 27,fair in 2. The degrees of dorsiflexion ranged from 7° to 18°,degrees of plantar flexion ranged from26° to 47°. After surgery,2 patients with Meta plate fixation showed flexion contracture,and 6 patients had an insensitivity of ankle joint activity（ 3 cases were fixed with Meta plate,the other 3 cases were fixed with 1/3 tubular plate）.Conclusions In the surgical treatment of posterior malleolus fracture,it can obtain good curative effect to select a reasonable internal fixation based on the size and shape of fracture block,the type of fracture line,the condition of soft tissue,the characteristics of bone and the characteristics of internal fixation via the posterolateral approach.