天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 205-209.doi: 10.11958/20161082

• 临床研究 • 上一篇    下一篇

后踝骨折手术入路选择探讨

杨国跃 1， 江汉 1， 刘智 1， 陈志清 1， 侯晓斌 1， 张洪 2△   

  1. 1 天津医科大学三中心临床学院骨科 （邮编 300170）； 2 解放军总医院第一附属医院骨科
  • 收稿日期:2016-09-27 修回日期:2016-12-28 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail：zhanghonggmd@163.com E-mail:xindewo2006@163.com
  • 作者简介:杨国跃 （1979）， 男， 副主任医生， 博士在读， 主要从事关节外科和创伤骨科研究

Selection of surgical approach for posterior malleolar fracture

YANG Guo-yue1, JIANG Han1, LIU Zhi1, CHEN Zhi-qing1, HOU Xiao-bin1, ZHANG Hong2△   

  1. 1 Department of Orthopedics, the Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China； 2 Department of Orthopedics, the First Affiliated Hospital of PLA General Hospital
  • Received:2016-09-27 Revised:2016-12-28 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail: zhanghonggmd@163.com E-mail:xindewo2006@163.com

PDF (PC)

3720

摘要： 目的 探讨后踝骨折临床特点以及如何进行手术入路选择。方法 对 2013 年 1 月—2015 年 9 月在我院接受手术治疗的后踝骨折病例资料进行回顾性分析， 共 83 例。根据踝关节三维 CT 进行 Haraguchi 分型 ， 其中 HaraguchiⅠ型 54 例、 HaraguchiⅡ型 16 例、 Haraguchi Ⅲ型 13 例。根据不同骨折分型选择相应手术入路进行切开复位内固定术。HaraguchiⅠ型、 Haraguchi Ⅲ型采用后外侧入路； HaraguchiⅡ型后踝骨折根据是否合并内踝骨折分别采用后内侧入路和跟腱旁后内侧入路。术后 2 周、 4 周、 12 周、 6 个月、 12 个月拍摄踝关节正侧位像。通过 X 线及临床检查判断骨折愈合时间， 记录并发症及相应转归。末次随访时根据美国矫形足踝协会（AOFAS）踝与后足评分标准和 SF-36 分别评价术后踝关节功能和术后患者生活质量。结果 83 位患者获得 6～24 个月随访， 平均 （15.4±6.2）个月， 骨折全部愈合， X 线愈合时间 12～24 周， 平均 （18.6±4.2） 周。AOFAS 踝与后足评分为 71～100 分， 平均 （88.4± 8.4） 分； 获优 67 例、 良 14 例、 中 2 例， 优良率为 97.59%。SF-36 生理评分 31.6～69.2 分， 平均 （48.4±4.8） 分， SF-36 心理评分 28.6～64.5 分， 平均 （45.8±3.5） 分。术后踝关节慢性疼痛 1 例， 诊断为创伤性关节炎， 经口服非甾体类药物治疗， 踝关节疼痛可缓解。术后发生浅表软组织感染 1 例， 经伤口换药后延迟愈合。所有病例未发生钢板螺钉松动、断裂等内固定失败并发症。结论 根据后踝骨折 Haraguchi 分型及骨折解剖特点有针对性地选择后外、 后内、 跟腱旁后内侧入路进行切开复位内固定手术， 可获得满意手术效果。

关键词: 踝关节, 后踝骨折, 骨折固定术, 内, 手术入路, 治疗结果

Abstract: Objective To investigate the clinical characteristics of posterior malleolar ankle fracture, and the selection of the surgical approach. Methods From January 2013 to September 2015, 83 cases of posterior malleolar fractures were retrospectively analyzed. Haraguchi typing was performed based on the three- dimensional CT. There were 54 cases with HaraguchiⅠ type, 16 cases with HaraguchiⅡ type, and 13 cases with HaraguchiⅢ type. The patients who were HaraguchiⅠ and Haraguchi Ⅲ types accepted the operation with posterolateral approach. The patients who were Haraguchi Ⅱtype and combined medial malleolus fracture accepted the operation with medial approach. The Haraguchi Ⅱ patients who were not combined medial malleolus fracture were used the medial paraachilles approach. Images of the ankle joint were filmed 2 weeks, 4 weeks, 12 weeks, 6 months and 12 months after the surgery. The healing time, complications and corresponding record outcome were determined by X-ray and clinical examination. At the last follow-up, ankle function and quality of life of patients were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and SF-36. Results Eighty-three patients were follow-up for 6-24 (mean 15.4± 6.2) months. The fractures healed on Xray. The average X-ray healing time was from 12 to 24 (mean 18.6±4.2) weeks. AOFAS score was 71 to 100 (mean 88.4±8.4) points. Sixty-seven cases were excellent, 14 cases were good, 2 cases were moderate, and good rate was 97.59%. SF-36 physiological score was 31.6-69.2 points(mean 48.4±4.8 points); SF-36 psychological score 28.6-64.5 points(mean 45.8± 3.5 points). Chronic ankle pain was complained by one patient. He was diagnosed traumatic arthritis, oral non- steroidal drugs was used to relief his ankle pain. One patient wound infected, and healed after treatment. No instrument failure and fracture displacement were found. Conclusion According to fracture morphology and clinical features after posterior malleolar ankle fracture, different surgical approaches are selected, which will be satisfied with the outcome.

Key words: ankle joint, posterior malleolar fracture, fracture fixation, internal, surgical approach, treatment outcome