后外侧入路切开复位内固定治疗三踝骨折

目的评价采用后外侧入路切开复位内固定治疗三踝骨折的价值。方法自2009-03—2012—06采用后外侧入路切开复位内固定治疗三踝骨折23例，处理外踝骨折时钢板放置于腓骨后侧或外侧，对后踝骨折行钢板或螺钉固定。观察术后切口及骨折愈合情况，术后3、12个月采用AOFAS踝一后足评分标准评价踝关节功能。结果术后3个月23例均获得随访，术后12个月2例失访。术后7d2例外侧和内侧切口周围同时出现张力性水泡．2例外侧切口周围出现张力性水泡，未出现切口感染。1例出现足背外侧麻木，术后3个月复诊时症状消失。术后3个月X线片显示23例骨折线均模糊，AOFAS评分：优12例，良8例，可2例，差1例，优良率86．96％。术后12个月X线片显示骨折线均消失，AOFAS评分：优17例，良2例，可2例，优良率90．48％。结论采用后外侧入路行切开复位内固定术治疗三踝骨折可以一次性复位固定外踝和后踝骨折，联合内侧切口可以一个体位下完成三踝骨折的治疗，对软组织破坏少，骨折可获得解剖复位,术后踝关节功能恢复佳、并发症少。

Posterolateral approach for open reduction and internal fixation of trimalleolar ankle fractures

Objective To evaluate posterolateral approach for open reduction and internal fixation（ORIF） of trimalleolar ankle fractures. Methods Twenty three patients with trimalleolar fractures were treated surgically from March 2009 to June 2012, using of the posterolateral approach. Plate was placed in the posterior or lateral of fibula, screws or plate fLxed the posterior malleolus. Wound healing and fracture healing were observed, and the ankle function was evaluated according to the AOFAS in 3 months and 12 months after surgery. Results Three months after surgery, 23 patients were followed, 12 months after surgery, 2 patients were lost. Seven days after surgery, 2 cases appeared tension blister in lateral and medial incision, 2 cases appeared tension blister in lateral incision, no wounds were infected. One ease appeared numbness in the lateral dorsum of foot, and numbness disappeared after 3 month. After 3 months all 23 cases showed fracture lines were fuzzy in X-ray, with AOFAS score： excellent in 12 cases, good in 8 cases, 2 cases in moderate, poor in 1 case, the excellent and good rate was 86.96%. After 12 months all 21 cases showed fracture lines disappeared in X-ray, with AOFA$ score： excellent in 7 cases, good in 2 cases, 2 cases in moderate, the exceUent and good rate was 90.48%. Conclusion Posterolateral approach for open reduction and internal fixation （ORIF） of trimalleolar ankle fractures can take reposition and fixation lateral maUeolus and posterior malleolar fracture at the same time. Combined with medial incision surgery for the trimalleolar ankle fractures can be completed in a position. This approach has less injury to soft tissue and less complications, better functional recovery of ankle joint.