微创经皮内固定治疗三踝骨折

目的探讨微创经皮内固定治疗三踝骨折的临床疗效。方法2002年1月～2005年10月,对28例(平均38.7岁)三踝骨折采用微创切开复位经皮内固定,Gatellier-Chastang后外侧入路显露外踝及外踝后方。骨折复位固定顺序为后踝、内踝、外踝、下胫腓联合。术后进行石膏固定3～4周。结果所有患者均获得随访,随访6～36个月(平均18个月),骨折全部愈合,愈合时间2.8～4.5个月,平均3.2个月。根据Baird-Jackson评分系统评估疗效:优16例,良8例,可3例,差1例,优良率85.7%。结论三踝骨折的解剖复位、稳固内固定是治疗的关键;微创经皮内固定是治疗三踝骨折较好方法,切口小可以减少骨折段血运的破坏,提高骨折愈合率。

Treatment of the trimalleolar fracture by minimally invasive surgical osteosynthesis

Objective To discuss clinical results of treatment of trimalleolar fractures by minimally invasive surgical osteosynthesis. Methods From January 2002 to Doctober 2005, twenty-eight cases (mean age: 38.7 years) of trimalleolar fracture were treated by minimally invasive surgical osteosynthesis. Their lateral and posterior ankle joints were exposed through the Gatellier-Chastang incision. The sequence of reduction and fixation of ankle fracture was firstly the posterior ankle, then the medial and lateral malleolus, and distal tibiofibular syndesmosis lastly. Postoperatively, all the patients were fixed externally from 3 to 4 weeks with plaster splint. Results Follow-ups of 18 months on average revealed that all the cases healed. The healing time ranging from 2.8 to 4.5 months averaged 3.2 months. According to the Baird-Jackson scoring system, the results were rated as excellent in 16 cases, good in eight cases, moderate in three cases, and poor in one case, with the good-excellent rate being 85.7% . Conclusions The anatomical reduction and firm internal fixation are key factors in treatment of trimalleolar fractures. The minimally invasive surgical osteosynthesis is a good method due to the minimal invasion, a high rate of union, and fewer complications it results in.