前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效

  目的  探讨经前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效，为此类临床问题的解决提供参考。  方法  2018年1月—2019年12月蚌埠医学院第二附属医院收治陈旧性内踝骨折患者9例，均为扭伤所致，术前曾行时间不等的非手术治疗，病程为43~128(83.0±34.6)d。采用前内侧入路切开复位拉力螺钉固定并自体松质骨植骨治疗，3例伴三角韧带损伤者加用带线锚钉修复。术后观测骨折愈合时间、手术并发症，测量并比较术前及末次随访时内踝间隙宽度及踝-后足评分系统(AOFAS)评分评价其疗效。  结果  9例患者随访12~36(24.7±7.6)个月，术后3~5(3.8±0.7)个月骨折愈合，无血管神经损伤、踝关节不稳或创伤性关节炎。末次随访时，内踝间隙宽度由(4.4±0.9)mm缩小至(2.4±0.3)mm，AOFAS评分由(47.3±6.2)分升高至(93.4±9.3)分，与术前比较差异有统计学意义(均P < 0.01)。依据AOFAS评分，优6例，良2例，可1例，优良率为88.9%。  结论  前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折，骨折愈合率高，并发症少，足踝功能恢复良好。 

The effect of old medial malleolus fracture via anterior medial approach with lag screw fixation and autogenous bone graft

  Objective  To explore the effect of old medial malleolus fracture via anterior medial approach with lag screw fixation and autogenous bone graft to provide a reference for the treatment of this kind of clinical problem.  Methods  From January 2018 to December 2019, nine patients with old medial malleolus fracture because of sprain were admitted. They went through non-surgical treatment for different times. The treatment course ranged from 43 to 128 (83.0±34.6) days. The patients were treated with open reduction and lag screw fixation and autogenous cancellous bone graft via anterior medial approach. Three cases with deltoid ligament injury were repaired with suture anchor. Fracture healing time and operative complications were observed after the operation. The medial malleolus gap width and AOFAS score were compared before operation and at the last follow-up.  Results  Nine patients were followed up for 12-36 (24.7±7.6) months. The fracture healing time was 3-5 (3.8±0.7) months. No complications such as blood vessel and nerve injury, unstable ankle and traumatic arthritis were observed. At the last follow-up, the medial malleolus gap width decreased from (4.4±0.9) mm to (2.4±0.3) mm, and the AOFAS score increased from (47.3±6.2) points to (93.4±9.3) points. There were significant differences between preoperative values and values at the last follow-up (all P < 0.01). According to the AOFAS score, six cases were excellent, two cases were good, and one case was fair. The excellent and good rate was 88.9%.  Conclusion  In the treatment of old medial malleolus fracture, lag screw fixation and autogenous bone graft via anterior medial approach have the advantages of high rate of fracture healing, few complications and good recovery of foot-ankle function.