联合入路开放复位内固定HaraguchiⅡ型后踝骨折

Combined approaches for open reduction and internal fixation of Haraguchi type Ⅱ posterior malleolus fractures

摘要:

［目的］ 探讨后外联合后内侧入路开放复位内固定后踝骨折的临床疗效。［方法］ 2017 年 7 月—2020 年 6 月，本科采用后外联合后内侧入路开放复位内固定 29 例 Haraguchi Ⅱ型后踝骨折患者的临床资料。评价临床与影像资料。［结果］所有患者均顺利完成手术，手术时间 72~123 min，平均（85.2±18.7） min，术中出血量 30~80 ml，平均（47.4±23.8） ml，手术切口均愈合良好。所有病例均获随访 15~34 个月，平均（20.1±3.5）个月。随术后时间延长，AOFAS 评分、VAS 评分和踝关节活动度均逐渐改善 （P<0.05）。影像显示骨折复位质量，优 24 例，良 5 例，优良率为 100.0%。骨折愈合时间 11~15 周。末次随访时，3 例踝关节退变评级为 1 级，术后各时间点差异无统计学意义 （P>0.05），无骨折移位、骨折不愈合及内固定松动。［结论］后外联合后内侧入路治疗后踝骨折，骨折端显露充分，利于骨折复位及固定，关节功能恢复良好。

Abstract:

[Objective] To evaluate the clinical efficiency of the posterolateral combined with the posteromedial approaches for open re- duction and internal fixation (ORIF) of posterior malleolus fractures. [Methods] From July 2017 to June 2020, 29 patients received ORIF of Haraguchi type Ⅱ posterior malleolus fractures through the posterolateral combined with the posteromedial approaches in our department. Clinical and imaging documents of the patients were evaluated. [Results] All the patients had the operation performed smoothly, with opera- tion time of 72~123 min with a mean of (85.2±18.7) min and the intraoperative blood loss of 30~80 ml with a mean of (47.4±23.8) ml, and good incision healing. All of them were followed up for 15 to 34 months, with an average of (20.1±3.5) months. The AOFAS score, VAS score and ankle range of motion significantly improved over time postoperatively (P＜0.05) . Radiographically, the quality of fracture reduc- tion was excellent in 24 cases, good in 5 cases and poor in 0 case, with an excellent and good rate of 100.0%. All the patients got fracture healed in 11~15 weeks postoperatively, with grade 1 ankle degeneration in 3 patients, which was not significantly different among each time points after operation (P＞0.05) , however, no fracture displacement, fracture nonunion and internal fixation loosening were noted in anyone of them until the latest follow-up. [Conclusion] The posterolateral combined with posteromedial approaches is fully exposed posterior mal- leolus fractures, which is conducive to fracture reduction and fixation with satisfactory function recovery.