改良后外侧入路治疗三踝骨折临床疗效分析

目的探讨改良后外侧人路在三踝骨折治疗中的临床疗效。方法2010年10月～2012年10月对32例三踝骨折的病例采用改良的后外侧人路行切开复位内固定治疗。根据Lauge—Hansen踝关节骨折分型，旋后外旋型18例，旋前外旋型14例。观察术后伤口愈合、骨折恢复及内固定情况，同时按Phillips踝关节评分标准踝关节功能进行评估。结果本组随访12～18个月，骨折全部愈合，愈合时间为10～13周。术后切口表浅感染1例。根据术后踝关节功能根据Phillips踝关节评分标准，本组评分为110～150分，平均（140．7±5．5）分；获优20例，良好7例，一般4例，差1例，优良率为84．3％。结论改良的踝关节后外侧手术人路不仅可充分显露后踝骨折，同时可兼顾外踝骨折的整复固定，减少手术切口及损伤，术野显露清晰，值得临床推广。

Efficacy analysis of the modified posterolateral approach for trimalleolar fractures

Objective To evaluate the clinical outcomes and efficiency the modified posterolateral approach for trimalleolar fractures. Methods From October 2010 to October 2012,32 patients with trimalleolar fractures were treated,including 18 males and 14 females,aged from 20 to 65 years. Fractures were classified with Lange- Hansen classification system： supination-external rotation in 18 cases,and pronation-external rotation in 14 cases. The patients were followed in outpatient clinic way.The fracture healing and ankle function were observed by the X-ray examinations postoperatively. Results All patients got follow-up visit for at least 12 months （from 12 to ,18 months,mean 14 months）.1 case of all incision was infected Superficially. Postoperative radiograph showed bone union in all the patients.At the final follow-up,according to Phillips ankle scoring system,the score ranged from 110 to 150,with an average of （ 140.7± 5.5 ）. There was excellent in 20 cases,good in 7 cases,fair in 4 cases and poor in 1 case,with an excellent and good rate of 84.3%. Conclusion The modified posterolateral approach can treat the fractures of lateral and posterior malleolar fractures simultaneously,less invasive and has characteristics of good surgical exposure,accurate fracture reduction,and worthwhile for spreading in clinical practice.