改良后外侧入路联合内侧入路治疗三踝骨折

目的 探讨后外侧跟腱旁人路联合内侧入路治疗三踝骨折的疗效及预后.方法 采用后外侧跟腱旁人路联合内侧人路治疗三踝骨折6例,男、女各3例;年龄40～68岁,平均年龄为(52.0±1.6)岁;左侧2例,右侧4例.致伤原因为交通事故伤5例,重物压伤1例.骨折类型根据AO分型,44-A3.2型1例,44-A3.3型1例,44-B3.2型3例,44-B3.3型1例;根据Lange-hansen分型,旋后外旋型4例,旋前外展型2例.采用后外侧跟腱旁人路行后踝骨块及外踝内固定,随后联合内侧入路行内踝内固定,骨折端均未进行植骨.术后随访,观察骨折的愈合情况及内置物稳定情况.结果 手术时间为60～120 min,平均为(90.0±3.4)min.术后住院时间为5～7 d,平均为(6.3±0.8)d.所有患者均获随访,随访时间为4～17个月,平均为(12.6±2.1)个月.所有患者在最后一次随访时切口均一期愈合,患肢均无畸形愈合,无骨折再移位,无内置物松动、内固定切出及内固定失败,无伤口感染及骨不连.骨折愈合时间为3～5个月,平均为(4.2±0.4)个月.所有患者均恢复到正常的步行功能状态,无需借助辅助工具.结论 采用后外侧跟腱旁人路联合内侧入路进行内固定治疗三踝骨折,其操作简便,固定可靠,跟腱旁入路可一次性完成后踝骨块及外踝的内固定.

Modified posterolateral approach combined with medial approach for trimalleolar fracture

Objective To evaluate the efficacy and prognosis of modified posterolateral approac hcombined with medial approach for treatment of trimalleolar fracture. Methods Six patients with trimalleolar fracture (2 left and 4 right) were treated with modified posterolateral approach combined with medial approach. The patients included 3 males and 3 females, with an average age of (52.0±1.6) years old (40--68 years old). The causes of injuries included traffic accidents (5 patients) and weight crushing injury (1 patient). According to AO classification, one case had 44-A3.2, one had 44-A3.3, 3 had 44-B3.2,and one had 44-B3.3. According to Lange-hansen classification, 4 cases had supination-extorsion and 2 had pronation-abduction. All the 6 patients received internal fixation using the modified posterolateral approach combined with medial approach, with no implants for the fracture ends. The bone union and the stability of the implants were observed during the follow-up. Results The average operation time was (90.0±3.4) min (60- 120 min), and the post-operative hospital stay was (6.3±0.8) days (5- 7 days). All the patients were followed up for (12.6± 2.1) months (4 - 17 months) averagely. The incisions of all patients had primary healing, and there were no malunion, re-displacement, implant loosening, internal fixation failure, nonunion or infection. The healing time of the fracture was (4.2±0.4) months (3- 5 months) on average. All the patients achieved normal gait at the last follow-up. Conclusion Modified posterolateral approach combined with medial approach is a feasible and effective approach for trimalleolar fracture;it is easy to perform and the fixation is fastness. The modified posterolateral approach can achieve fixation of both lateral malleolus and Volkmann fracture simutaneously.