踝损伤的后踝骨折块由前向后空心螺钉固定

Anterior-posterior placement of cannulated screws for internal fixation of posterior malleolus fracture fragment in ankle in⁃ juries

摘要:

［目的］探讨由前向后空心加压螺钉内固定治疗后踝骨折块的临床疗效。［方法］2015 年 6 月—2020 年 9 月，对 53 例患者采用由前向后空心拉力螺钉内固定踝损伤的后踝骨折块，其中男 24 例，女 29 例。评价临床及影像结果。［结果］本组患者均顺利完成手术，手术时间平均 （87.23±9.50） min，术中失血量平均 （105.25±21.60） ml。患者恢复完全负重活动时间为 （2.08±0.78）个月。随平均随访（13.57±4.08）个月的时间推移，VAS 评分显著减少（P<0.05），而 AOFAS 评分，以及踝背伸跖屈 ROM 显著增加 （P<0.05）。影像方面，术后影像显示骨折复位满意，关节面移位距离较术前明显减小 （P<0.05），根据 Burwell-Charnley 评级，47 例解剖复位，6 例复位可。至末次随访时，所有患者骨折愈合，关节退变 Kellgren-Lawrence 评级 0 级 45 例，1 级 5 例，2 级 3 例。［结论］由前向后空心拉力螺钉可牢靠固定后踝骨折块，相对手术创伤小，有利于术后恢复。

Abstract:

[Objective] To explore the clinical outcomes of anterior-posterior placement of cannulated lag screw for internal fixation of posterior malleolus fracture fragment in ankle injuries. [Methods] From June 2015 to September 2020, a total of 53 patients, including 24 males and 29 females, received anterior-posterior placement of cannulated lag screw for internal fixation of posterior malleolus fracture frag- ment complicated in ankle injuries in our hospital. The clinical and imaging results were evaluated. [Results] All the patients had operation performed smoothly with operation time of (87.23±9.50) min, and intraoperative blood loss of (105.25±21.60) ml, and then resumed full weight-bearing activity in (2.08±0.78) months on an average postoperatively. As time went during the follow up lasted for a mean of (13.57± 4.08) months, the VAS scores significantly decreased (P＜0.05) , while AOFAS scores and ankle dorsal extension- plantar flexion range of motion (ROM) significantly increased (P＜0.05) . Radiographically, postoperative images showed satisfactory fracture reduction achieved in all the patients, with significantly declined displacement distance of articular surface compared with that before surgery (P＜0.05) . Accord- ing to Burwell-Charnley criteria, 47 patients were marked as anatomic fracture reduction, while the remaining 6 patients as acceptable re- duction. By the time of last follow-up, all patients got fracture union with the joint degeneration of grade 0 in 45 cases, grade 1 in 5 cases, and grade 2 in 3 cases in term of Kellgren-Lawrence classification. [Conclusion] This anterior and posterior placement of cannulated screws does firmly fix the posterior malleolus fracture fragment in ankle injuries, which minimizes the iatrogenic trauma and is beneficial to postoperative recovery.