后内联合后外侧入路治疗伴内外踝骨折的后踝两部分骨折

摘要

Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.%目的 探讨后内联合后外侧入路治疗伴内外踝骨折的后踝两部分骨折的疗效.方法 回顾性研究2014年1月至2017年1月同济大学附属同济医院骨科通过后内联合后外侧入路治疗的26例伴内外踝骨折的后踝两部分骨折患者资料.其中男10例,女16例;年龄53～67岁,平均61.5岁.俯卧位下后内外侧联合入路,同时显露内、外、后踝骨折端,同时复位,外踝采用钢板固定,后踝骨块根据大小采用管型钢板或螺钉固定,内踝骨折采用螺钉固定.术后采用美国足踝外科协会(AOFAS)踝-后足评分及疼痛视觉模拟评分(VAS)评估疗效.结果 本组22例患者术后获得随访,平均30个月(12～48个月).所有患者术后无感染,切口均Ⅰ期愈合.术后X线片复查显示平均骨折愈合时间为12.5周(10～15周).无骨折不愈合及内固定物松动、断裂.患者术后平均13周(11～16周)时可完全负重行走,无明显疼痛不适.22例患者末次随访时AOFAS踝-后足评分平均为85.4分(80～92分),其中优13例,良9例,优良率100%.VAS评分由术前(8.6±0.6)分改善为术后(1.7±0.3)分,差异有统计学意义(t=153.000,P=0.000).结论 俯卧位下后内外侧联合入路治疗伴内外踝骨折的后踝两部分骨折,能同时显露复位并固定内、外、后踝骨折端,疗效满意.