后外侧、后内侧入路手术治疗三踝骨折伴踝关节脱位的临床疗效分析

Clinical effect of posterolateral and posteromedial approaches for trimalleolar ankle fractures with ankle dislocation

目的分析探讨后外侧、后内测入路手术治疗三踝骨折伴踝关节脱位的临床治疗效果。方法24例三踝骨折伴踝关节脱位患者,取后外侧入路行外踝、后踝骨折钛板内固定,后踝骨折偏内侧则取后内侧入路行钛板内固定,取内侧入路行内踝骨折钢板或螺钉内固定。观察治疗效果。结果所有患者随访11~24个月,平均随访(17.42±3.82)个月,随访率100%。所有切口均一期甲级愈合,所有骨折经X线检查均骨性愈合,且内固定物位置形态良好,无松动、脱出、变形、断裂等情况。根据AOFAS踝-后足功能评分量表对患者踝关节功能进行临床疗效评价:优19例,良3例,可2例,优良率91.67%。结论应用后外侧、后内侧入路手术治疗三踝骨折伴踝关节脱位具有较好的临床疗效,能较好的恢复踝关节功能,安全性较高,取得了较为满意的结果。

Objective To analyze the clinical effect of posterolateral and posteromedial approaches for trimalleolar ankle fractures with ankle dislocation.Methods 24 patients with tri-ankle fractures and ankle dislocations underwent posterolateral approach for internal fixation of the lateral ankle and hind ankle fracture with titanium plate.The medial posterior malleolus fractures were treated with internal fixation of medial ankle fracture plates or screws via posteromedial approache.The therapeutic effect was observed.Results All patients were followed up for 11-24 months,with an average follow-up of(17.42±3.82)months,and the follow-up rate was 100%.All the incisions were healed at Grade A,all fractures were healed by X-ray examination,and the position of the internal fixation was good.There was no loosening,prolapse,deformation,or fracture.According to the AOFAS ankle hind foot function scale,the clinical effect of ankle joint function was evaluated:excellent in 19 cases,good in 3 cases,fair in 2 cases,the excellent-good rate was 91.67%.Conclusion Posterolateral and posteromedial approaches shows good clinical efficacy for the treatment of trimalleolar ankle fractures with ankle dislocation,and can better restore the function of the ankle joint with high safety,and has achieved relatively satisfactory results.