经腓骨后缘入路联合后前位中空螺钉治疗旋后外旋型踝关节骨折

Treatment of supination and external rotation ankle fractures with posterior fibular approach combined with posteroanterior cannulated screw

目的探讨经腓骨后缘入路联合后前位中空螺钉治疗旋后外旋型踝关节骨折的临床疗效。方法采用经腓骨后缘入路联合后前位中空螺钉治疗56例旋后外旋型踝关节骨折患者。记录手术时间、术中出血量、骨折复位情况、骨折愈合时间、并发症发生情况。采用AOFAS踝-后足功能评分标准评价踝关节功能恢复情况。结果患者均获得随访,时间12~18(15.24±4.37)个月。手术时间55~115(72.37±16.74)min,术中出血量15~45(33.06±12.73)ml。骨折均达到解剖复位。无腓肠神经、腓浅神经、腓深动脉等术中损伤;无拇趾屈曲异常、螺钉激惹、骨折延迟愈合和不愈合等术后并发症发生。骨折均一期愈合,时间8~16(11.8±3.2)周。术后12个月,AOFAS踝-后足功能评分72~96(87.74±9.86)分,其中优41例,良12例,可3例,优良率94.6%(53/56);踝关节活动度:跖屈35°~50°(39.4°±8.0°),背伸15°~25°(20.7°±4.6°)。结论采用经腓骨后缘入路联合后前位中空螺钉治疗旋后外旋型踝关节骨折,手术创伤小、易复位、固定可靠、并发症少、患者术后踝关节功能恢复满意。

Objective To investigate the clinical effect of posterior fibular approach combined with posteroanterior cannulated screw in the treatment of supination and external rotation ankle fractures.Methods The 56 patients with supination and external rotation ankle fractures were treated by posterior fibular approach combined with posteroanterior cannulated screws.The operation time,intraoperative blood loss,fracture reduction,fracture healing time,and complications were recorded.The AOFAS ankle-hindfoot function score was used to evaluate the recovery of ankle joint function.Results All patients were followed up for 12~18(15.24±4.37)months.The operation time was 55~115(72.37±16.74)min,and the intraoperative blood loss was 15~45(33.06±12.73)ml.The fractures were all obtained the anatomical reduction.There were no intraoperative injuries of the sural nerve,superficial peroneal nerve,deep peroneal artery;no postoperative complications such as abnormal flexion of the great toe,screw irritation,delayed union and nonunion occurred.All fractures healed in one-stage,the fracture healing time was 8~16(11.8±3.2)weeks.At 12 months after operation,the AOFAS ankle-hindfoot function score was 72~96(87.74±9.86)points,of which 41 cases were excellent,12 cases good,and 3 fair,with an excellent-good rate of 94.6%(53/56).Ankle range of motion:plantar flexion with 35°~50°(39.4°±8.0°),dorsiflexion with 15°~25°(20.7°±4.6°).Conclusions The treatment of supination and external rotation ankle fractures with posterior fibular approach combined with posteroanterior cannulated screw has the advantages of less surgical trauma,easy reduction,reliable fixation,few complications,and satisfactory recovery of ankle joint.