后内外不同入路治疗内侧延伸型后踝骨折疗效比较

目的：探讨经后内侧和后外侧两种术式治疗内侧延伸型后踝骨折的临床疗效。方法：自2008年1月至2011年1月,采用空心拉力螺钉治疗内侧延伸型后踝骨折患者25例。15例采用经后内侧切口入路拉力螺钉内固定（后内侧切口组）,其中男9例,女6例;年龄21-67岁,平均（48.1±1.3）岁。按Denis-Weber AO骨折分型：A型5例,B型6例,C型4例。10例采用经后外侧切口拉力螺钉内固定（后外侧切口组）,其中男6例,女4例;年龄23-64岁,平均（46.9±1.5）岁。Denis-Weber AO骨折分型：A型3例,B型5例,C型2例。记录并比较两组患者的手术时间、术中出血量、切口长度、X线暴露次数及并发症发生情况,术后采用Baird-Jackson评定标准对两组患者的功能评价。结果：25例患者均获随访,时间12-49个月,平均20.6个月。两组患者手术时间、术中出血量、X线暴露次数、并发症情况比较差异有统计学意义（P〈0.05）;两组患者疗效比较差异无统计学意义（P〉0.05）。结论：后内侧入路治疗内侧延伸型后踝骨折,可以在直视下显露和固定骨折块,具有手术耗时短、X线暴露次数少、术中出血量少的优点,是值得选择的手术入路方式。

Therapeutic effects of treatment of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision

Objective: To explore clinical outcomes of posterior malleolar fractures with medial-extension type through posterioromedial and posteriorlateral incision. Methods: From January 2008 to January 2011,25 patients with posterior malleolar fractures with medial-extension type were treated by hollow lag screw. Among them,15 patients were treated through posteromedial incision,including 9 males and 6 females,aged from 21 to 67 years old with an average of 48.1±1.3;there were 5 cases with type A,6 cases with type B and 4 cases with type C,according to Denis-Weber classification. Ten patients were treated by through posterior-lateral incision,including 6 males and 4 females,aged from 23 to 64 years old with an average of 46.9±1.5;there were 3 cases with type A,5 cases with type B and 2 cases with type C,according to Denis-Weber classification. Operation time,blood loss,length of incision,times of X-ray exposure and complications of two groups were recorded and compared,Baird-Jackson effective evaluation were applied for evaluate clinical outcomes. Results: All patients were followed up from 12 to 49 months with an average of 20.6 months. There were significant differences in operation time,blood loss,times of X-ray exposure and complications between two group(P<0.05). While there was no obvious meaning in clinical outcomes between two groups(P>0.05). Conclusion: Treating posterior malleolar fractures with medial-extension type through posteromedial approach can expose and fix fracture under direct vision,has advantages of shorter operation time,less X-ray exposure and blood loss,is a good choice of surgical approach.