两种踝关节改良入路在三踝骨折手术中的分类应用
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甘肃省平凉市庄浪县人民医院

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Classification and application of two modified ankle approaches in the trimalleolar fracture surgery
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Department of Orthopedics, People’s Hospital of Zhuanglang County, Gansu Province, Zhuanglang 744699, China

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    摘要:

    目的 观察两种踝关节改良入路分类治疗三踝骨折的疗效。 方法 回顾性分析甘肃省庄浪县人民医院骨科自2014年12月至2019年12月收治的32例三踝骨折的患者资料,男20例,女12例;年龄20~65岁,平均47.1岁;踝部骨折根据AO分类:A3型11例,B3型21例。根据术前X线片及三维CT检查,将所有病例分为2组,后踝骨折偏外(外侧组,22例),采用改良后外侧及内侧切口;后踝骨折偏内(内侧组,10例),采用改良后内侧及外侧切口。后踝及内踝采用空心加压螺钉固定,外踝采用钢板固定,记录两种入路手术时间,观察术中后踝暴露范围、术后骨折愈合时间及并发症情况,末次随访时采用Olerud-Molander踝关节骨折功能评分评价踝关节功能。 结果 2组患者手术时间为60~110min,平均80min。2组术中后踝骨折暴露清楚。32例患者获12-18个月(平均14个月)随访。术后4~8个月所有骨折均骨性愈合。3例患者出现切口皮下感染,无深部感染,无骨不连、创伤性关节炎等并发症发生。末次随访时采用Olerud-Molander踝关节骨折功能评分评价踝关节功能:优19例,良11例,可2例。 结论 两种踝关节改良入路分类治疗三踝骨折,骨折显露清楚,复位良好,减少了创伤性关节炎的发生,值得推广。

    Abstract:

    Objective To observe the clinical efficacy of two modified approaches of ankle jointsthrough the classified treatment of trimalleolar fracture surgery. Methods From December 2014 to December 2019, 32 patients with trimalleolar fractures were treated at the Department of Orthopedics, People’s Hospital of Zhuanglang County, Gansu Province. They were 20 males and 12 females, aged from 20 to 65 years (mean, 47.1 years). Classified by the AO for an ankle injury, 11 cases belonged to A3 and 21 cases to B3. According to preoperative X-ray film and 3D CT examination, all cases were divided into two groups.Modified incisions from lateral to medial were adopted when posterior malleolus fractures were lateral (lateral group, 22 cases). Modified incisions from medial to lateral were used when posterior ankle fractures were medial (medial group, 10 cases).The medial malleolus and the posterior malleolus werefixed with hollow compression screws and the lateral malleolus was fixed with steel plates. The operation time of two approaches, exposurerangeof posterior malleolus during operation, fracture healing time, and postoperative complications were observed and recorded. At the last follow-up, ankle function was assessedby theOlerud-Molander ankle fracture function score. Results In the 32 patients, the operation time of the two groups ranged from 60 to 110min (mean, 80 min). The fracture of the posterior malleolus was clearly exposed during operation in two groups. Of the two groups, 32 patients were followed up for 12 to 18 months (mean, 14 months). All fractures healed from 4 to 8 months after the operation. Incision subcutaneous infection was observed in 3 cases.No such complicationsoccurred like deep infection, nonunion of anklebone or traumatic arthritis. Accessed by the Olerud-Molander ankle fracture function score at the last follow-up, the ankle function was excellent in 19 cases, good in 11, and fair in 2. Conclusion Treatment of trimalleolar fracture by two modified approachesof ankle joint shows clearly fracture and good reduction, which reduces the occurrence of traumatic arthritis and is worth popularizing.

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  • 收稿日期:2022-01-09
  • 最后修改日期:2022-04-28
  • 录用日期:2022-09-16
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