后外侧入路在治疗后踝骨折中的应用

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doi：10.3969/j.issn.1007-614x.2014.21.31

摘 要 目的：探讨经后外侧入路行后踝骨折内固定的方法及疗效。方法：2010年8月-2012年6月采用踝关节后外侧入路治疗后踝骨折37例，根据Lauge-Hansen踝关节骨折分型，旋后外旋型17例，旋前外展型13例，旋前外旋型7例。均采用后外侧入路行切开复位空心拉力螺钉或钢板内固定，术中采用“拉钩实验”检查下胫腓联合的稳定性，必要时行3层皮质骨螺钉固定。术后定期随访，随访时间8～17个月（平均13.2个月）。结果：所有随访患者伤口均一期愈合，无骨折再移位，无内置物松动、切出，所有骨折均骨性愈合，采用美国足踝外科协会（AOFAS）推荐的踝足评分系统评分：优28例，良5例，可3例，差1例，优良率89.2%。结论：采用后外侧入路治疗后踝骨折，创伤小，显露清晰，可直视下精确复位关节面，并方便内固定物植入，推荐在固定后踝骨折时常规使用。

关键词 后踝骨折 后外侧入路 治疗

The application of posterolateral approach in the treatment of posterior malleolar fracture

Li Ke，Sun Gang，Feng Lei

Department of Ankle Surgery，Orthopedics Hospital of Nanyang City，Henan 473000

Abstract Objective：To investigate the method of posterior lateral line fixed posterior malleolar fracture and its efficacy.Methods：37 cases with posterior malleolar fracture who were treated with the ankle joint posterior lateral approach were selected from August 2010 to June 2012.According to the lauge-hansen ankle fracture type，17 cases of supination external rotation type，13 cases of pronation and abduction type，7 cases of pronation external rotation type.All of the posterior malleolar fracture were treated with posterolateral incision reduction and cannulated lag screw or plate fixation，the“hook experiment” were used to check the stability of tibiofibular in the operation.When necessary，3 layers of cortical bone screws were used to fixed it.Regular follow-up after operation，the time of follow-up was 8～17 months （average 13.2 months）.Results：All followed-up cases were primary healing，no fracture displacement，no implant loosening or cut out，all the fractures healed.According to the ankle foot scoring system score recommended by the America association of foot and ankle surgery （AOFAS）：excellent in 28 cases，good in 5 cases，well in 3 cases，poor in 1 cases，the rate of excellent and good was 89.2%.Conclusion：The posterolateral approach to the treatment of posterior malleolar fracture was trauma，show clear.It can directly precise articular surface reduction，and convenient to fixation implant.So it is necessary to recommended for routine use in the fixation of posterior malleolus fractures.

Key words Posterior malleolar fracture；Posterolateral approach；Treatment

踝关节是人体的主要负重关节之一，该部位骨折占全身骨折的3.9%，其中，累及后踝的骨折占踝关节骨折的14%～44%[1-2]，后踝复位的稳定性和平整度直接影响患者的功能恢复和远期创伤性关节炎的发生率，在复杂踝关节骨折损伤中，后踝骨折的复位固定是手术治疗的难点，这就要求术中选择一个好的手术入路以直观显露后踝骨折，给复位固定提供便利，2010年8月-2012年6月采用后外侧入路复位固定后踝骨折，疗效满意，现报告如下。

资料与方法