后外侧入路治疗胫腓骨下段开放性骨折临床分析

目的探讨经后外侧入路治疗胫腓骨下段开放性骨折临床疗效。方法新鲜胫腓骨下段开放性骨折患者28例（28处骨折），所有骨折均Ⅰ期清创缝合和外固定，待消肿后Ⅱ期经后外侧入路内固定治疗。结果全部病例获12-41个月随访，骨折均获愈合，平均愈合时间为25．4周。无深部感染和其他软组织并发症发生，1例因严重伸肌腱损伤致足下垂，术后半年行跟腱延长和肌腱转住术，术后2年发生创伤性关节炎而行胫距关节融合术。按照美国足踝外科协会（AOFAS）制定的足-踝评分系统评价，优15例，良9例，可3例，差1例，优良率85．7％。结论Ⅱ期经后外侧入路切开复住内固定是治疗胫腓骨下段开放性骨折的一种有效方法，此法固定可靠，术后软组织并发症少，踝关节功能恢复满意。

The clinical analysis of the treatment with posterolateral approach for distal tibia and fibula open fractures

Objective To observe the effect of posterolateral approach for treatment of distal tibia and fibula open fracture.Methods Twenty-eight patients with 28 fracture sites were enrolled.All fractures were treated with debridement and temporarily fixation at first phase.with an internat fixation through posterolateral approach at second phase.Results Twenty-eight cases were followed up from 12 to 41 months.All fractures healed well.The average union time was 25.4 weeks without deeD infection occurred.Meanwhile ankle function recovered well.One patient has drop foot due to badly injured extensor tendon,and he had achilles tendon lengthening and tendon transposition surgery 6 months later,followd by fusion of tibiotalar joint due to traumatic arthritis after 2 years.According to American Orthopaedic Foot & Ankle Society (AOFAS) scoring system,15 cases had excellent scores,9 were good,3 were fair and 1 was bad,and the overall percentage of excellent and good scores was 85.7%.Conclusion The second stage open reduction and internal fixation through posterolateral approach for distal tibia and fibula open fractures is an effective therapy.Posterolateral approach affiliates stable fixation and ankle function recovery,with less wound tissue complications.