经后外侧入路切开复位内固定与闭合复位内固定在后踝骨折中的疗效观察

目的观察经后外侧入路切开复位内固定与闭合复位内固定治疗后踝骨折的疗效。方法选择该院2013年4月至2015年10月行手术治疗的合并后踝骨折的35例踝关节骨折患者,其中经后外侧入路切开复位内固定25例(切开复位组),闭合复位内固定10例(闭合复位组)。观察两组患者手术时间、术后非负重时间、骨折愈合时间。术后12个月采用Olerud-Molander踝关节功能评分系统对两组患者的踝关节功能进行比较。结果切开复位组患者的手术时间、术后骨折愈合时间较闭合复位组长,差异有统计学意义(P<0.05)。切开复位组与闭合复位组患者术后4周可逐渐下地适当负重,两组患者非负重时间差异无统计学意义(P>0.05)。所有手术患者均在5~7个月内获得骨性愈合。切开复位组患者踝关节功能评分为(83.51±8.44)分,闭合复位组为(80.83±9.61)分,差异无统计学意义(P>0.05)。结论经后外侧入路切开复位内固定与闭合复位内固定在治疗后踝骨折中的临床效果相近。切开复位内固定手术时间长,骨折部位软组织损伤重;闭合复位内固定技术要求高,术中情况复杂。对于后踝骨折块较大且受伤时间较短的患者可首选闭合复位内固定治疗,对于后踝骨折块较小或医师闭合复位操作经验较少的情况下尽量选用切开复位内固定治疗。

Observation on effect of open reduction internal fixation and closed reduction internal fixation by posterolateral approach in treating posterior malleolus fracture

Objective To observe the effect of open reduction internal fixation and closed reduction internal fixation by posterolateral approach for treating posterior malleolus fracture.Methods The patients with complicating posterior malleolus fracture treated in the hospital from April 2013 to October 2015 were selected,including 25 cases of open reduction internal fixation by posterolateral approach(open reduction group)and 10 cases of closed reduction internal fixation(close reduction group).The operation time,fracture healing time and postoperative non-weight-bearing time were observed in the two groups.The ankle joint functions in postoperative 12 months were compared between the two groups according to the Olerud-Molander ankle joint function scoring system.Results The operating time and facture healing time in the open reduction group were longer than those in the close reduction group,the differences were statistically significant(P<0.05).The patients in the two groups gradually began to get out of bed and conduct the proper bear loading in postoperative 4 weeks.The postoperative non-weight-bearing time had no statistical difference between the two groups(P>0.05).All operated cases obtained the clinical healing within 5-7 months.The ankle joint functions score in the open reduction internal fixation group was(83.51±8.44)points,which in the close reduction group was(80.83±9.61)points,and the difference was not statistically significant(P>0.05).Conclusion The clinical effect of open reduction internal fixation by posterolateral approach is similar to that of closed reduction internal fixation in the treatment of ankle fracture.The operation time of open reduction internal fixation is long,local soft tissue injury is heavy,closed reduction internal fixation requires high technology,and the intraoperation situation is complex.For the patients with large posterior malleolus fracture pieces and short injury time,the close reduction internal fixation may be the first selection,under the condition of small posterior malleolus fracture pieces or less experience of closed reduction operating,the open reduction should be selected as much as possible.