后外侧入路与传统外侧入路治疗不稳定型三踝骨折的疗效比较

Comparison of the efficacy of posterolateral approach and traditional lateral approach in the treatment of unstable tri-ankle fractures

目的比较分析后外侧入路与传统外侧入路治疗不稳定型三踝骨折的临床疗效。方法回顾性分析2012年1月-2020年3月诊治的60例不稳定型三踝骨折手术患者,根据患者经济条件、功能需求及手术方案的可行性,将患者分为观察组(采用后外侧手术入路30例)和对照组(采用传统外侧手术入路30例),对比分析两组踝关节活动度、骨折愈合时间、术后并发症及Barid-Jackson评分。结果60例均获得随访,随访时间平均14.5个月。术前两组年龄、病程、合并伤、Lauge-hanson分型比较差异无统计学意义(P≥0.05);术后两组骨折愈合时间及并发症比较差异无统计学意义(P≥0.05);末次随访时,观察组踝关节活动度及Barid-Jackson评分明显优于对照组,差异有统计学意义(P<0.05)。结论采用后外侧入路治疗不稳定型三踝骨折可兼顾后踝骨折术野暴露,术中能够精准完成后踝复位内固定,其疗效优于传统外侧入路。

Objective To compare and analyze the clinical efficacy of posterolateral approach and traditional lateral approach in the treatment of unstable tri-ankle fractures.Methods Retrospective analysis of 60 patients with unstable tri-ankle fractures diagnosed and treated in our hospital from January 2012 to December 2019.According to the patient's economic conditions,functional needs and the feasibility of the surgical plan,the patients were divided into experimental group(using posterolateral surgical approach,30 cases)and control group(using traditional lateral surgical approach,30 cases),compared and analyzed the ankle joint mobility,fracture healing time,postoperative complications and Barid-Jackson score of the two groups of patients.Results All 60 patients were followed up for an average of 14.5 months.There was no significant difference in age,course of disease,combined injury,and Lauge-hanson classification between the two groups before surgery(P≥0.05).There was no statistical difference in fracture healing time and complications between the two groups after surgery(P≥0.05).At the last follow-up,the ankle joint mobility and Barid-Jackson score of the experimental group were significantly better than the control group,and the difference was statistically significant(P<0.05).Conclusion Incision of posterolateral approach for unstable triple ankle fractures can be considered for exposure of posterior ankle fractures,The posterior ankle reduction and internal fixation can be accurately completed during the operation,and its efficacy is better than the traditional lateral approach.