文章摘要

经后外侧入路应用钢板或空心钉治疗旋后外旋IV 度踝关节骨折中大块后踝骨折的疗效

作者: 1单 涛, 1周 业金, 1宁 仁德
1 合肥市第一人民医院创伤骨科,合肥 230001
通讯: 周 业金 Email: 1505406085@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.02.016

摘要

目的:分析经后外侧入路支持钢板和空心钉治疗旋后外旋IV度踝关节骨折中大块后踝骨折的疗效。方法:合肥市第一人民医院自2016年8月至2018年8月经后外侧入路选取2种内固定方式治疗旋后外旋IV度踝关节骨折大块后踝骨折72例,其中男41例,女31例,年龄21~67(平均42.86)岁。支持钢板组40例,男23例,女17例;空心钉组32例,男18例,女14例。通过比较手术时间、手术出血量、骨折愈合时间、术后并发症、1年后美国足踝外科协会(American Orthopaedic Foot & Ankle Society,AOFAS)踝-后足评分及优良率来评定手术效果。结果:所有患者随访12~16(平均13.13)个月,切口均I期愈合,无切口裂开、骨折延迟愈合、不愈合现象。术后1年踝关节AOFAS评分,空心钉组评分为80.72±14.56,其中优11例,良15例,可4例,差2例,优良率81.3%;钢板组评分为86.60±10.07,优15例,良19例,可5例,差1例,优良率85.0%。两组手术时间、手术出血量及术后1年踝关节AOFAS评分差异有统计学意义(P<0.05),骨折愈合时间比较差异无统计学意义(P>0.05)。钢板组手术并发症发生率7.5%,空心钉组12.5%,差异无统计学意义(P>0.05)。 结论:经后外侧入路支持钢板治疗旋后外旋IV度踝关节骨折中大块后踝骨折更能获得良好的踝关节功能,手术效果更显著。
关键词: 支持钢板;空心钉;后踝骨折;后外侧入路

Effects of posterolateral approach with buttress plates or cannulated screw fixation for type IV large posterior malleolus fractures of ankle with supination-external rotation

Authors: 1SHAN Tao, 1ZHOU Yejin, 1NING Rende
1 Department of Traumatic Orthopedics, The First People’s Hospital of Hefei, Hefei 230001, China

CorrespondingAuthor:ZHOU Yejin Email: 1505406085@qq.com

Abstract

Objective: To analyze the effectiveness of buttress plates and cannulated screw in the treatment of type IV large posterior malleolus fractures of ankle with supination-external rotation via the posterolateral approach. Methods: Between August 2016 to August 2018, 72 patients (41 males and 31 females; age from 21 to 67 years, mean age 42.86 years) with type IV large posterior malleolus fractures of ankle with supination-external rotation were treated by cannulated screw or buttress plate fixation by the posterolateral approach. The posterior malleolus fractures were fixed with buttress plate, including 23 males and 17 females. The posterior malleolus fractures were fixed with cannulated screw, including 18 males and 14 females. The operative time, perioperative blood loss, the bone healing time and the postoperative complications were assessed. Ankle joint function was evaluated according AOFAS scoring system. Results: All the patients were followed for 12–16 months (13.13 months on average). After the follow-up period, no incision dehiscence, delayed fracture healing, non-healing phenomenon was observed. According to the AOFAS scoring system, the outcomes in buttress plate group were rated as excellent in 15 cases, good in 19, fair in 5, and poor in only 1 case, for an excellent and good rate of 85.0%. And the outcomes in cannulated screw group were rated as excellent in 11 cases, good in 15, fair in 4, and poor in only 2 case, for an excellent and good rate of 81.3%. There were significant differences between the two groups in operative time, perioperative blood loss and the AOFAS score (P<0.05). The complication formation rate (buttress plate group 7.5%, cannulated screw group 12.5%) and the bone healing time for two groups were no significant differences (P>0.05). Conclusion: A posterolateral approach with buttress plate internal fixation could be more effective technique for reduction and fixation of type IV large posterior malleolus fragments of ankle with supination-external rotation.
Keywords: buttress plate; cannulated screw; posterior malleolus fracture; posterolateral approach