后踝内侧垂直联合线后前入路治疗后踝骨折的临床研究

Clinical study of posterior to anterior approach with posteromedial vertical syndesmotic line in treatment of posterior malleolus fractures

目的 探讨参考后踝内侧垂直联合线(PVSL)行闭合复位经皮后前(PA)入路空心拉力螺钉内固定治疗后踝骨折的临床效果。方法 选择2020年1月至2022年1月于我院后踝骨折患者23例,均参考PVSL行闭合复位经皮PA入路空心拉力螺钉内固定治疗。记录患者术后骨折复位、踝关节功能恢复、并发症发生及恢复情况。结果 23例患者术后获得6~20个月的随访。术后所有患者后踝骨折块均得到良好复位,移位均小于2 mm。X射线显示,患者骨折均全部愈合,骨折愈合时间3~6个月。美国足踝外科协会(AOFAS)踝-后足评分为76~100分,平均(89.8±8.2)分;术后踝关节功能优17例、良5例、中1例,优良率为95.7%。所有患者均未发生螺钉松动、断裂等并发症。结论 参考PVSL闭合复位经皮PA入路空心拉力螺钉内固定治疗后踝骨折手术效果显著,值得临床推广应用。

Objective To explore the clinical effect of closed reduction and internal fixation with percutaneous cannulated screws through posterior to anterior(PA)approach with reference to posteromedial vertical syndesmotic line(PVSL)for the treatment of posterior malleolus fractures.Methods A total of 23 patients with posterior malleolus fractures in our hospital from January 2020 to January 2022 were slected,and received closed reduction and internal fixation with percutaneous cannulated screws through PA approach with reference to PVSL.The fracture reduction,functional recovery of ankle joint,occurrence of complications,and rehabilitation of patients after surgery were recorded.Results After surgery,23 patients were followed up for 6 to 20 months.After surgery,the posterior malleolar fracture fragments of all patients were of good reduction,with the displacement less than 2 mm.The X-ray showed that all fractures healed,with the fracture healing time of 3 to 6 months.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores ranged from 76 to 100 points,with an average of(89.8±8.2)points;the ankle joint function was excellent in 17 cases,good in 5 cases,and moderate in 1 case,with an excellent and good rate of 95.7%.No complications such as screw loosening or breakage occurred in all cases.Conclusion The closed reduction and internal fixation with percutaneous cannulated screws through PA approach with reference to PVSL has a significant surgical effect for posterior malleolus fractures,which is worthy of clinical promotion and application.