后外侧联合内侧入路急诊内固定治疗三踝骨折

Emergency internal fixation for treatment of trimalleolar fracture via posterolateral combined with medial approach

目的探讨后外侧联合内侧入路急诊内固定治疗三踝骨折的疗效。方法对23例三踝骨折患者急诊采用后外侧入路行后踝骨折复位空心螺钉或支撑钢板内固定、外踝骨折复位钢板内固定,内侧入路行内踝骨折复位空心螺钉内固定。末次随访时采用AOFAS踝-后足功能评分标准评价疗效。结果患者均获得随访,时间10~32个月。切口均一期愈合。骨折均愈合,时间10~20周。无畸形愈合、螺钉松动、钢板断裂等并发症发生。末次随访时采用AOFAS踝-后足功能评分标准评价疗效:优19例,良3例,可1例,优良率22/23。结论后外侧联合内侧入路急诊内固定治疗三踝骨折,可较为轻松完成后踝—外踝—内踝骨折的复位和坚强固定,同时也可对下胫腓联合复位固定,临床效果满意。

Objective To explore the clinical effect of emergency internal fixation for treatment of trimalleolar fracture via posterolateral combined with medial approach.Methods All the 23 cases of trimalleolar fractures were performed with emergency surgery,using cannulated screw or supporting plate via posterolateral approach for posterior malleolar fracture,lateral malleolar fracture reduction and plate internal fixation,and medial malleolar fracture reduction and cannulated screw internal fixation with medial approach.At the last follow-up,AOFAS ankle-hindfoot function score was used to evaluate the efficacy.Results All patients were followed up for 10~32 months.All the incisions healed in the first stage,and the fractures healed within 10~20 weeks.No complications such as malunion,screw loosening and plate fracture occurred.At the last follow-up,AOFAS ankle-hindfoot function score was used to evaluate the curative effect:excellent in 19 cases,good in 3 cases,fair 1 case,the excellent-good rate was 22/23.Conclusions Emergency internal fixation via posterolateral combined with medial approach for trimalleolar fracture can easily complete the reduction and rigid fixation of posterior malleolus-lateral malleolus-medial malleolus fracture,and which can also fix the tibiofibular syndesmosis,with satisfactory clinical effect.