改良踝关节后外侧入路联合内侧入路治疗三踝骨折的效果

Effect of Modified Posterolateral Approach to Ankle Joint Combined with Medial Approach on Trimalleolus Fracture

目的:探讨改良踝关节后外侧入路(PLA)联合内侧入路治疗三踝骨折的效果。方法:回顾性分析2019年1月-2021年6月晋江市医院晋南分院收治的71例三踝骨折患者的临床资料,所有患者均接受内固定复位术治疗,其中接受传统踝关节PLA联合内侧入路的36例患者为传统组,接受改良踝关节PLA联合内侧入路的35例患者为改良组。比较两组疗效、手术及骨折愈合情况、视觉模拟评分法(VAS)评分、踝关节功能、术后并发症。结果:两组疗效比较,差异无统计学意义(P>0.05)。改良组手术时间、住院时间均短于传统组,术中出血量少于传统组(P<0.05)。两组骨折愈合时间比较,差异无统计学意义(P>0.05)。改良组术后1、2、3 d的VAS评分均低于传统组(P<0.05)。术后3、6个月及术后1年,改良组的踝关节跖屈、背伸活动度均大于传统组,Baird-Jackson评分均高于传统组(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:内固定复位术中无论采用改良踝关节PLA或传统踝关节PLA联合内侧入路治疗三踝骨折均能获得良好的效果,有利于术后骨折愈合,但改良入路的优势在于可减少术中出血和手术时间,加快患者术后出院,并减轻术后早期疼痛,而对减少术后并发症无明显积极作用。

Objective:To investigate the effect of modified posterolateral approach(PLA)to ankle joint combined with medial approach in the treatment of trimalleolus fracture.Method:The clinical data of 71 patients with trimalleolar fracture admitted to Jinnan Branch of Jinjiang Municipal Hospital from January 2019 to June 2021 were retrospectively analyzed,all patients received internal fixation reduction treatment,including 36 patients received traditional PLA to ankle joint combined with medial approach was traditional group and 35 patients received modified PLA to ankle joint combined with medial approach as the improved group.The efficacy,surgical and fracture healing,visual analog scale(VAS)scores,ankle function and postoperative complications were compared between the two groups.Result:There was no significant difference in efficacy between the two groups(P>0.05).The operation time and hospital stay of the improved group were shorter than those of the traditional group,and the intraoperative blood loss was less than that of the traditional group(P<0.05).There was no significant difference in fracture healing time between the two groups(P>0.05).VAS scores of the improved group were lower than those of the traditional group at 1,2 and 3 d after surgery(P<0.05).At 3,6 months and 1 year after surgery,ankle plantar flexion and dorsalflexion motion in the improved group were higher than those of the traditional group,and Baird-Jackson scores were higher than those of the traditional group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Both modified PLA to ankle joint and traditional PLA to ankle joint combined with medial approach in the treatment of trimalleolus fracture during internal fixation reduction can achieve good curative effect,which is conducive to postoperative fracture healing,however,the advantages of the improved approach are that it can reduce intraoperative bleeding and operation time,accelerate postoperative discharge of patients,and alleviate early postoperative pain,but has no significant positive effect on reducing postoperative complications.