后外侧入路治疗后踝骨折的疗效及并发症

目的：探讨后外侧入路治疗后踝关节骨折的临床疗效及并发症。方法：采用后外侧入路治疗后踝骨折患者34例，采用Lauge-Hansen分型，旋后-外旋型26例；旋前-外旋型损伤8例。CT检查显示27例后踝骨折块占胫骨远端关节面积大于25%，7例大于10%，骨折移位程度均大于2 mm。术后采用Baird-Jackson踝关节功能评定标准对患者踝关节功能进行评价。结果：34例患者均获得随访，平均随访12.5个月。术后2周伤口一期愈合。复查X线检查，骨折对位满意，后踝骨折均获得骨性愈合。4例患者出现腓肠神经支配区麻木，2例患者术后半年完全恢复，1例有所好转，1例无明显改善。3例患者踝部疼痛明显，取出外踝钢板后症状消失。Baird-Jackson踝关节评分优20例，良9例，可4例，差1例，优良率85.3%。结论：后外侧入路治疗后踝骨折便于骨折复位且固定牢靠，可同时处理腓骨骨折。

Effects and Complications in Treatment of Displaced Posterior Malleolar Fracture through Posterolater-al Approac

Objective To analyze the clinical effects and complications of treatment of posterior malleolar fracture with posterolateral approach. Methods Posterior malleolar fractures were treated through the postero-lateral approach in 34 patients. Medial malleolar fracture was found in 23, medial deltoid ligament rupture in 4, lateral malleolar fracture in all patients.According to Lauge-Hansen system,supination external rotation was found in 26, pronation external rotation in 8.CT scan showed that the size of fragment exceeded 25%of the artic-ular surface in 27,and in 7cases exceeded 10%.All displacements were more than 2mm.The ankle function was evaluated by Baird-Jackson criteria. Results All patients were followed up for average 12.5 months.The wounds healed in all patients postoperatively 2 weeks. X-Ray showed all cases healed with accurate reduction. Four patients had numbness in the sural distribution.Two patients had complete resolution following surgery six months,one patient had improvement,one patient had still symptoms.According to the Baird-Jackson criteria,the results were rated as excellent in 20, good in 9,moderate in 4, and poor in 1, with the good-excellent rate being 85.3%. Conclusion The posterolateral approach is the optimal method that provides excellent visualization,fa？cilitates more accurate reduction and rigid fixation.