踝部骨折后内入路微型钢板固定后内侧骨折块

Mini plate fixation of posteromedial fragment in posterior malleolar fractures via posteromedial approach

摘要:

[目的] 介绍踝部骨折后内入路微型钢板固定后内侧骨折块的手术与治疗技术和初步临床结果。[方法] 2019 年2月—2021 年2 月本院手术治疗踝关节骨折伴后内侧骨折块患者12 例。伤后1~10 d 进行手术治疗，取俯卧位或漂浮体位，后外侧切口内完成后内侧骨折块和外踝的复位固定后，后内侧入路经胫骨后肌腱和胫后血管神经窗口显露后内侧骨折块和后丘骨折块，分别复位后经F3 微型锁定钢板塑形后整体支撑固定，同时完成前丘骨折螺钉或张力带固定。[结果] 12 例手术均顺利完成，术中无血管神经损伤，手术时间平均（111.8±26.2） min。随访时间12~18 个月，骨愈合时间8~12 周。末次随访时，VAS评分0~3 分，AOFAS 踝及后足评分86~96 分，无内置物失效及骨折复位丢失者，胫距关节面匹配良好。[结论] 踝部骨折后内入路微型钢板固定可以有效固定后内侧骨折块，减少内置物相关并发症，有利于踝关节功能恢复，是一种可行的手术方法。

Abstract:

[Objective] To introduce the surgical technique and clinical outcomes of F3 mini locking plate for ankle fractures com-bined with posteromedial fragment. [Methods] From February 2019 to February 2021, 12 patients underwent surgical treatment for anklefractures complicated with posteromedial fragment in our hospital with time interval from injury to surgery from 1 to 10 days. Surgical expo-sure was adopted among anterior and posterior window between tibialis posterior and neurovascular bundle through posteromedial ap-proach. Following reduction, fixation of fractures was conducted, including screw or tension band fixation of the anterior collicular fragment,posteromedial and posterior collicular fragment, and F3 mini locking plate for overall fixation. [Results] There was no intraoperative neuro-vascular injury, no incision infection and flap necrosis in anyone of them. No posterior tibialis tendon irritation and implant failure, loss offracture reduction as well as joint incongruity were observed in anyone at the last follow-up. The AOFAS ankle-hind foot score was from 86to 96 at the latest follow-up. [Conclusion] The fixation of posteromedial fragment with F3 mini-locking plate can achieve effective stabili-ty, reduce implant-related complications, and facilitate the recovery of ankle function, which is a feasible surgical scheme.