对不同入路治疗含后踝压缩骨块三踝骨折的疗效分析

Comparative study on different approaches in the treatment of trimalleolar fracture for posterior ankle compression

目的比较采用经腓骨入路与后外侧入路治疗含后踝压缩骨块的三踝骨折的临床疗效。方法回顾性分析2014年6月—2017年6月深圳平乐骨伤科医院创伤科罗湖院区及坪山院区收治71例含后踝压缩骨块的三踝骨折患者的临床资料,比较并分析两组手术情况、术后踝关节功能、并发症。结果所有患者术后获平均18(12~48)个月随访,骨折均获骨性愈合。两组在手术时间、术中出血量、术中透视次数、参与术者人数等方面比较差异无统计学意义(P>0.05)。末次随访时Baird-Jackson踝关节评分显示,经腓骨入路组优11例,良19例,可4例,优良率88.24%;后外侧入路组优12例,良21例,可4例,优良率89.19%,功能评分比较差异无统计学意义(P>0.05)。经腓骨入路组3例皮肤边缘坏死,不良事件发生率为8.82%(3/34);后外入路组2例皮肤边缘坏死,2例患足踇趾屈曲畸形,1例腓肠神经损伤,不良事件发生率为13.51%(5/37)。结论两种入路疗效均满意,后外侧入路治疗含后踝压缩骨块的三踝骨折并发症略多。

Objective To compare the clinical efficacy and complications of fibula approach and posterolateral approach in the treatment of trimalleolar fractures in posterior ankle compression.Methods The clinical data of 71 cases of trimalleolar fractures with posterior ankle compression,treated in Department of Trauma,Pingle Orthopedics and Traumatology Hospital from June 2014 to June 2017,were retrospectively analyzed.The operation,ankle function and complications were compared and analyzed between the two groups.Results All patients were followed up for an average of 18(12-48)months.Bone healing was achieved in all cases.There were no significant differences in operation time,intraoperative blood loss,intraoperative fluoroscopy times and the number of participants between the two groups(P>0.05).Baird-Jackson ankle joint score at the last follow-up.Pseudomonas got excellent 11 cases,good 19 cases,general 4 cases,excellent rate 88.24%.There were 12 excellent cases in the posterior lateral approach group;21 cases were good;and 4 cases were possible.The excellent rate was 89.19%.There was no significant difference in functional score(P>0.05).Three case had skin edge necrosis through fibula approach;the incidence of adverse events was 8.82%(3/34).Two case had skin edge necrosis through posterior and external approach;two case had toe flexion deformity;one case had sural nerve injury;the incidence of adverse events was 13.51%(5/37).Conclusion Both the approaches are satisfactory,and the posterior lateral approach has slightly more complications in the treatment of three ankle fractures for posterior ankle compression.