两种入路开放复位内固定三踝骨折比较

Comparison of two approaches for open reduction and internal fixation of trimalleolar fractures

摘要:

[目的]比较两种入路开放复位内固定三踝骨折的临床疗效。[方法]2014 年 12 月—2020 年 12 月手术治疗 32 例三踝骨折患者，其中 17 例采用后外侧入路显露后踝(外侧组)，15 例采用后内侧入路显露后踝(内侧组)。比较两组患者围手术期资料、随访结果。[结果]两组患者手术均达解剖复位，术中无神经、血管损伤等并发症。两组手术时间、术中失血量、切口愈合等级的差异均无统计学意义(P＞0.05)；外侧组显露后踝切口长度显著长于内侧组(P＜0.05)。两组患者均获 1 年以上随访。 两组恢复完全负重时间、末次随访 AOFAS 评分及踝关节 ROM 的差异均无统计学意义(P＞0.05)。[结论] 两种入路均可显露后踝，用于三踝骨折开放复位内固定，应依据后踝骨折的具体情况选择使用。

Abstract:

[Objective] To compare the clinical efficacy of two approaches for open reduction and internal fixation (ORIF) of trimalleolar fractures. [Methods] From December 2014 to December 2020, 32 patients received ORIF of trimalleolar fractures, including 17 patients with posterior malleolus exposed by posterolateral approach (lateral group) and 15 patients with posterior malleolus exposed by posteromedi- al approach (medial group). The perioperative and follow-up documents were compared between the two groups. [Results] Anatomic reduc- tion was achieved in all patients of both groups, without complications such as nerve and blood vessel injury. There were no significant differ- ences in operation time, intraoperative blood loss and wound healing between the two groups (P＞0.05). The incision length for exposing poste- rior malleolus was significantly longer in the lateral group than in the medial group (P＜0.05). All patients in both groups were followed up for more than 1 year, without a significant differences in the time to resume full- weight activity, as well as AOFAS score and ankle ROM be- tween the two groups at latest follow-up (P＞0.05). [Conclusion] Both approaches can expose the posterior malleolus effectively in open re- duction and internal fixation of trimalleolar fractures, which should be selected based on the concrete condition of the posterior malleolus fractures.