俯卧位双切口治疗三踝骨折应用体会

目的俯卧位下踝关节后外侧入路辅助内侧切口治疗三踝骨折的应用体会。方法选取2015年9月-2018年11月安徽省滁州市第一人民医院骨科收治的三踝骨折患者39例,根据Lauge-Hanse分型分为旋后外旋型24例,旋前外展型10例,旋前外旋型3例,旋后内收型1例,垂直压缩型1例,所有患者均采用俯卧位下后外侧入路辅助内侧切口内固定治疗。手术体位均采用俯卧位,后外侧入路先复位固定外踝,外踝复位后,由于后侧关节囊的牵张作用,复位固定后踝相对容易,术中采用"拉钩实验"检查下胫腓联合的稳定性,必要时在外踝处行3层皮质骨螺钉固定下胫腓联合,内固定顺序是外踝、后踝,最后辅助内侧切口复位固定内踝,处理外踝骨折时钢板放置于腓骨后侧或外侧。术中辅以C型臂X线机荧屏监视证实三踝骨折的解剖复位及内固定牢靠。术后随访观察骨折复位、愈合及踝关节功能情况。结果 39例患者均得到随访,平均随访13(4~26)个月。术后半年全部采用Baird-Jackson踝关节评分系统进行评分,超过95分者10例(25.6%),介于91~95分者23例(59.0%),5例评分介于81~90分之间,1例评分低于80分,总优良率为84.6%。结论俯卧下后外侧入路辅助内侧切口治疗三踝骨折,操作简单方便,可直视下复位固定后踝骨折块,同时外踝及内踝也能获得良好显露、复位与固定,临床疗效确切,适用于三踝骨折手术。

Application experience of double incisions in prone position for treatment of trimalleolar fracture

Objective To study the application of anterolateral approach to ankle joint under prone position to assist medial incision in the treatment of trimalleolar fracture. Methods Thirty-nine patients with trimalleolar fracture admitted to the Department of Orthopedics, Chuzhou First People's Hospital, Anhui Province from September 2015 to November 2018 were selected. According to Lauge-Hanse classification, 24 cases were supination-abduction type, 10 cases were supination-abduction type, 3 cases were supination-abduction type, 1 case was supination-adduction type, and 1 case was vertical compression type. All patients were treated with medial incision internal fixation assisted by lower posterolateral approach in prone position. The operation position is prone position. The lateral malleolus is firstly restored and fixed through the posterolateral approach. After the restoration of lateral malleolus, it is relatively easy to restore and fix the posterior malleolus due to the stretching effect of the posterior joint capsule. During the operation, the stability of the lower tibiofibular syndesmosis is checked by "hook test". If necessary, the lower tibiofibular syndesmosis is fixed by 3-layer cortical bone screws at the lateral malleolus. The internal fixation sequence is the lateral malleolus and the posterior malleolus. Finally, the medial incision is assisted to restore and fix the medial malleolus, and the steel plate is placed at the posterior side or lateral side of During the operation, the anatomical reduction and internal fixation of trimalleolar fracture were confirmed by screen monitoring of C-arm X-ray machine. The fracture reduction, healing and ankle joint function were observed after operation. Results All 39 patients were followed up for an average of 13 (4-26) months. Baird-Jackson ankle joint scoring system was used in all six months after the operation, with 10 cases (25.6%) with more than 95 points, 23 cases (59.0%) with 91-95 points, 5 cases with 81-90 points, and 1 case with less than 80 points, with a total excellent and good rate of 84.6%. Conclusion Prone lower posterolateral approach assisted with medial incision for trimalleolar fracture is simple and convenient to operate. It can reduce and fix the posterior malleolar fracture block under direct vision. At the same time, lateral malleolus and medial malleolus can also be well exposed, reduced and fixed. It has definite clinical effect and is suitable for trimalleolar fracture surgery.