改良微创前内侧入路空心加压螺钉治疗内踝骨折的临床研究

Clinical study of modified minimally invasive anteromedial approach with hollow compression screw for medial malleolar fracture

目的设计内踝骨折改良微创前内侧入路,并探讨该入路使用空心加压螺钉治疗内踝骨折的临床效果。方法选择符合纳入标准的39例患者,使用改良微创前内侧入路治疗内踝骨折。对患者进行随访并记录,通过VAS(visual analogue scale,VAS)疼痛视觉模拟评分、美国足踝外科学会(American orthopaedic foot and ankle society,AOFAS)评分及踝关节功能评分(Kofoed评分标准)进行疗效评价。结果39例患者均获得术后随访13~20个月,平均(16.3±2.0)个月。全部患者获得骨性愈合,平均愈合时间(3.0±0.79)个月,无切口相关并发症发生。患者平均受伤至手术时间(3.2±1.4)d,手术时间平均(55.9±9.8)min,内踝手术切口长度平均(3.7±0.5)cm。根据术后12个月随访AOFAS评分平均(95.1±7.4)分:优31例(79.5%),良8例(20.5%),优良率100%。依据Kofoed踝关节功能评分本组患者平均(94.4±8.6)分:优32例,良6例,合格1例,优良率达97.4%。结论改良微创前内侧入路可以在微创的前提下直视复位关节面及皮质,在减少软组织骚扰的同时获得满意的复位效果,对绝大多数内踝骨折尤其是Herscovici B型和C型是一种理想的选择。

Objective To design a modified minimally invasive anteromedial approach(MMIAA)for medial malleolar fractures and to evaluate the clinical outcomes of treating medial malleolar fractures with hollow compression screws via MMIAA.Methods Thirty-nine patients who met the inclusion criteria were selected for the treatment of medial malleolar fractures using MMIAA.Patients were followed up and evaluated by visual analogue painscale(VAS),American Orthopedic Foot and Ankle Society(AOFAS)score and Ankle Function score(Kofoed scale).Results All 39 patients were followed up for 13-20 months,with a mean of(16.3±2.0)months.All patients achieved bony healing with a mean of(3.0±0.79)months.No incision-related complications were recorded.The mean time from injury to surgery was(3.2±1.4)d,the mean duration of operation was(55.9±9.8)min and the mean length of the surgical incision was(3.7±0.5)cm.According to 12-month follow-up,the mean AOFAS score was(95.1±7.4)points,which were excellent in 31 cases(79.5%)and good in 8 cases(20.5%),with an excellent and good rate of 100%.According to the Kofoed ankle function score with a mean of(94.4±8.6)points,32 cases were assessed as excellent,6 cases as good and 1 case as fair,with an excellent and good rate of 97.4%.Conclusion The MMIAA allows a direct visual repositioning of the articular surface and cortex in a minimally invasive manner,and minimizes soft tissue damage as well.MMIAA is an ideal option for most of medial malleolar fractures especially for Herscovici type B and type C.