关节镜监视下复位经皮空心螺钉固定后踝骨折

Arthroscopic reduction and fixation of posterior malleolar fracture with percutaneous cannulated screw

[目的]介绍关节镜监视下复位经皮螺钉固定后踝移位骨折的手术技术及初步临床效果。[方法] 2019年9月—2022年9月采用后侧入路关节镜监视下复位后踝骨折块、经皮空心螺钉固定手术技术治疗31例踝关节骨折。于内踝尖水平,跟腱两侧旁开1.5 cm作为关节镜入路,显露后踝骨折块向近端移位形成的胫骨远端关节软骨面台阶,关节镜监视下经皮撬拨复位后踝骨折块并置入空心螺钉固定。[结果] 31例患者均顺利完成手术,无血管神经损伤并发症,手术伤口均一期愈合,骨折愈合时间平均(9.4±2.3)周。与术前相比,末次随访时VAS评分[(6.1±1.9),(0.7±1.9), P<0.001]、AOFAS评分[(38.2±11.7),(97.4±5.8), P<0.001]、Maryland评分[(52.7±17.1),(95.5±6.3), P<0.001]均显著改善。术后影像显示28例关节弧面平整或台阶<1mm,3例关节内台阶<2 mm。[结论]此技术能够直视关节软骨面复位过程,准确复位,踝关节功能恢复良好,胫骨后侧软组织剥离范围减少,缩短骨愈合时间。

[Objective] To introduce the surgical technique and preliminary clinical results of percutaneous cannulated screw fixation of displaced posterior malleolar fractures under arthroscopic supervision. [Methods] From September 2019 to September 2022, 31 patients received percutaneous cannulated screw fixation of displaced posterior malleolar fractures under arthroscopic supervision for ankle fractures. At the level of the medial malleolar tip, lateral and medial portals 1.5 cm apart Achilles tendon were established. The arthroscope was introduced through the lateral portal to reveal the distal tibial articular cartilage step formed by the proximal displacement of the posterior malleolar fracture block. The posterior malleolar fracture block was reduced by percutaneous prying and fixed with cannulated screws under the surveillance of arthroscopy. [Results] All the 31 patients were operated on smoothly without complications of vascular and nerve injury, with the operative wounds healed in one stage, and fracture healing in(9.4±2.3) weeks on an average. Compared with those preoperatively, VAS [(6.1±1.9),(0.7±1.9), P<0.001], AOFAS [(38.2±11.7),(97.4±5.8), P<0.001] and Maryland score [(52.7±17.1),(95.5±6.3), P<0.001] were significantly improved by the time of the latest follow-up. Postoperative imaging showed that the articular arc was completely recovered or remained a step <2 mm in 28 cases, and a step >2 mm in 3 cases. [Conclusion] This technique has advantages of direct vision during operation, accurate reduce and fixation, minimizing posterior soft tissue involvement, which is conducive to recovery of ankle joint function, and fracture healing.