1/3管型防滑钢板治疗三踝骨折中后踝骨折的临床研究

目的探讨应用1/3管型防滑钢板治疗三踝骨折中后踝骨折的手术方法及临床疗效。方法收集2011年9月~2015年1月间我院58例三踝骨折包含后踝骨折患者,其中男26例,女32例。年龄21~72岁,平均46.5岁。对于后踝骨折使用1/3管型防滑钢板固定48例,单纯拉力螺钉固定10例。手术入路采用外踝外侧切口,外踝骨折复位固定后,沿跟腱外侧前缘切开深筋膜,显露踇短屈肌,切开部分骨膜或部分踇短屈肌,显露近端骨折线,然后复位、透视,并放置内固定。术后1周开始无负重功能锻炼,6周后拐杖或助行器下逐步部分负重,60岁以上患者术后8周开始逐步负重。结果所有患者均获得随访,随访时间6~18个月,平均13.5个月。随访期间,所有患者均获得Ⅰ期愈合,骨折愈合时间3~4.2个月,平均3.5个月。随访期内无术后复位丢失,无创伤性骨关节炎发生。术后采用Olerud-Molander评分标准对踝关节功能评分,钢板固定组术后6个月平均93.7分,单纯拉力螺钉固定组术后6个月平均91分。结论对于患者使用1/3管型防滑钢板治疗三踝骨折中后踝骨折具有复位精确、术后并发症少、实现早期功能锻炼及负重行走、能有效减少畸形愈合的优点,为三踝骨折中后踝骨折较理想的手术固定方法。

Clinical study on one-third tubular non-slip steel plate in the treatment of posterior malleolus fracture of triple-malleolus fracture

Objective To investigate the surgical method and clinical effect of applying one-third tubular non-slip steel plate in the treatment of posterior malleolus fracture of triple-malleolus fracture.Methods 58 patients with ankle fracture including posterior malleolus fracture from September 2011 to January 2015 in our hospital were collected,including 26 males and 32 females.And the patients were aged 21 to 72 years old,with an average of 46.5 years old.For the posterior ankle fracture,there were 48 cases of using one-third tubular non-slip steel plate for fixation and 10 cases of simple pull screw fixation.The lateral malleolus incision was used as surgical approach.After lateral malleolus fracture reduction and fixation,deep fascia was incised along lateral front edge of the achilles tendon,and short flexor was revealed.Part of the periosteum and short thumb flexor was incised.The proximal fracture line or short flexor was revealed,and then reset,perspective was performed.And internal fixation was placed.From one week after operation,no weight-bearing functional exercise was taken.6 weeks later,gradually partial load was added under crutches or aids.And the patients over 60 years of age started to gradually take load 8 weeks later.Results All patients were followed up for 6-18 months with an average of 13.5 months.During the follow-up period,all patients got the first phase of healing,and the fracture healing time was 3 to 4.2 months,with an average of 3.5 months.No postoperative reduction loss and no invasive osteoarthritis occurred during the follow-up period.The Olerud-Molander grading standard was used to evaluate the ankle joint function after surgery.The average score was 93.7 points in the plate fixation group and 91 points in simple pull screw fixation group at 6 months after surgery.Conclusion The one-third tubular non-slip steel plate in the treatment of posterior malleolus fracture of triple-malleolus fracture has the advantages of accurate reduction,less postoperative complications,early functional exercise and weight-bearing walking,which can effectively reduce malunion,and is an ideal surgical fixation for posterior malleolus fracture of triple-malleolus fracture.