| 夏胜利,马梓元,高峰,等.经腓骨后缘切口后外侧入路“后向前”螺钉治疗后踝骨折.骨科,2020,11(5): 382-386. |
| 经腓骨后缘切口后外侧入路“后向前”螺钉治疗后踝骨折 |
| Surgical treatment of posterior malleolus fractures with “P to A” screw fixation through posterolateral approach via posterior incision of fibula |
| 投稿时间：2020-03-16 |
| DOI：10.3969/j.issn.1674-8573.2020.05.007 |
| 中文关键词: 腓骨后缘切口 后外侧入路 空心螺钉 内固定 后踝骨折 |
| 英文关键词: Posterior incision of fibula Posterolateral approach Cannulated screw Internal fixation Posterior malleolus fractures |
| 基金项目:上海市浦东新区卫生健康委员会领先人才培养计划资助项目（PWR12018-09）；浦东新区中医药研发专项资助项目（PDZYYFCX-201818）；上海市浦东新区卫生健康委员会临床特色学科（PWYts2018-02）；上海市医学重点专科（ZK2019B05） |
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| 中文摘要: |
| 目的 探讨采用经腓骨后缘切口后外侧入路“后向前”空心螺钉内固定治疗后踝骨折的手术效果。方法 回顾性分析2017年1月至2019年7月我院采用经腓骨后缘切口后外侧入路“后向前”空心螺钉内固定治疗后踝骨折的50例病人，其中男21例，女29例；平均年龄为48岁（18~82岁），均为单侧骨折。所有病人均行后踝空心螺钉和外踝钢板固定，其中38例行内踝空心螺钉内固定，5例行内侧三角韧带修复，7例行下胫腓螺钉固定；收集手术时间及末次随访时的美国足踝医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分，根据术后X线片及CT结果评估后踝复位结果及植钉准确度。结果 本组平均手术时间为172.5 min（135~200 min）；术后影像学证实46例病人关节面获得完全解剖复位，关节面平整，4例病人存在2 mm以内的台阶，有5例后踝螺钉进入下胫腓间隙中；平均随访时间为14个月（6~24个月），未发现骨折复位丢失、再移位及螺钉松动；末次随访AOFAS评分：优25例、良23例、可2例，优良率为96%。病人均未出现切口感染及神经损伤等并发症。结论 经腓骨后缘切口后外侧入路空心螺钉“后向前”内固定治疗后踝骨折可以获得较好的临床疗效，但在采用该切口入路时后踝螺钉的植钉准确度有待提高。 |
| 英文摘要: |
| Objective To investigate the surgical effect of the treatment of posterior malleolus fractures in ankle fractures with “P to A” cannulated screw fixation through posterolateral approach via posterior incision of fibula. Methods A retrospective analysis was performed on 50 cases of ankle fractures treated with “P to A” cannulated screw fixation through the posterior incision of fibula from January 2017 to July 2019 in our hospital, including 21 males and 29 females, aged from 18 to 82 years old with an average of 48 years old. All were unilateral fractures. All cases were treated with posterior malleolus cannulated screw and lateral malleolus plate fixation: 38 cases were given medial malleolus cannulated screw fixation, 5 cases medial deltoid ligament repair, and 7 cases syndesmotic screw fixation. The operation time and the American Orthopedic Foot and Ankle Society (AOFAS) in the last follow-up were recorded. Postoperative X-ray and CT were performed to evaluate the results of reduction of posterior malleolus and the accuracy of screw implantation. Results The operation time was 135-200 min, with an average of 172.5 min. Postoperative imaging confirmed that 46 had complete anatomical reduction of posterior fragment with articular surface congruency, and 4 cases had residual step-off less than 2 mm. Posterior malleolus cannulated screws implanted into tibiofibular syndesmosis space by mistake were found in 5 cases. All of 50 cases were followed up for 6-24 months (average 14 months), and no loss of fracture reduction and loosening of screws was found. In the last follow-up, AOFAS scores were excellent in 25 cases, good in 23 cases and fair in 2 cases, with 96% of the excellent and good rate. No complications including incision infection and nerve injury occurred in all patients. Conclusion Internal fixation of posterior malleolus fracture with cannulated screws through the posterolateral approach via the posterior incision of fibula can obtain good clinical effects, but the accuracy of the screws implantation should be improved. |
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