三踝骨折与胫腓骨螺旋骨折中后踝骨折的回顾性研究

A retrospective study comparing posterior malleolar fracture in trimalleolar fracture and tibial spiral fracture

目的比较三踝骨折与胫腓骨螺旋骨折中后踝骨折的分型和治疗效果。方法选择后踝骨折患者157例,其中三踝骨折86例,胫腓骨螺旋骨折合并后踝骨折71例,术前观察后踝骨折的类型,术后观察患者的恢复情况。结果三踝骨折患者的骨折类型更为复杂,类型多为两部分且累及内踝。胫腓螺旋骨折合并后踝骨折患者开始负重时间短于三踝骨折患者,美国矫形外科足踝协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分高于三踝骨折患者,视觉模拟评分法(Visual Analogue Scale,VAS)评分低于三踝骨折患者,背屈受限程度低于三踝骨折患者,关节炎发生率小于三踝骨折患者,差异均有统计学意义(P<0.05)。结论同为后踝骨折,三踝骨折的预后较胫骨螺旋骨折合并后踝骨折更差,应针对三踝骨折采取更为严格的手术方式,以减少术后相关并发症的发生。

Objective To compare the classification of posterior malleolar fracture in tibial spiral and trimalleolar fracture.Methods A total of 156 patients were included in this research.86 of them were trimalleolar fracture,and the other 71 patients were tibial spiral fracture combined with posterior malleolar fractures.The classification of fracture were identified preoperatively,and functional outcomes were also evaluated postoperatively.Results The fracture types in patients with trimalleolar fracture were more complicated.Compared with trimalleolar fracture,the patients with tibial spiral fracture combined with posterior malleolar fractureshad a shorterweighting time,higher American Orthopaedic Foot and Ankle Society（AOFAS）score,lower Visual Analogue Scale（VAS）score,dorsiflexion-restriction were smaller,and the differences were significant in two groups（P〈0.05）.Conclusion For patients with trimalleolar fracture,the prognosis was inferior than that of tibial spiral fracture,and more careful plan should be conducted to decrease relative complications before operation.