| 叶文斌,陈志达,陈卫,等.一期后内侧和后外侧双切口治疗伴Bartonicek Ⅲ型后踝骨块的三踝骨折.骨科,2022,13(4): 315-319. |
| 一期后内侧和后外侧双切口治疗伴Bartonicek Ⅲ型后踝骨块的三踝骨折 |
| One-Stage Posterior Medial and Posterolateral Double Incision Open Reduction and Internal Fixation for the Treatment of Three Malleolar Fractures with Bartonicek Type Ⅲ Posterior Malleolus Fragment |
| 投稿时间：2022-03-26 |
| DOI：10.3969/j.issn.1674-8573.2022.04.006 |
| 中文关键词: 三踝骨折 手术入路 分型 内固定 疗效 |
| 英文关键词: Three malleolar fractures Approach Classification Internal fixation Therapeutic effect |
| 基金项目:漳州市自然科学基金（ZZ2018J10；ZZ2019J19）；全军军事训练伤防治研究专项（21XLS23） |
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| 中文摘要: |
| 目的 探讨一期后内侧和后外侧双切口切开复位内固定治疗伴Bartonicek Ⅲ型后踝骨块的三踝骨折的临床疗效。方法 回顾性分析2016年2月至2019年1月于我院治疗的23例伴Bartonicek Ⅲ型后踝骨块的三踝骨折病人的临床资料，其中男15例，女8例，年龄为（43.85±14.91）岁（19~67岁）。所有病人采用俯卧位用后内、后外侧双切口，同时显露内、外、后踝骨折端，按照外踝-后踝-内踝顺序复位骨折，外踝采用钢板固定，后踝依照骨块大小采用T型钢板或螺钉固定，内踝骨折根据骨折线形态采用螺钉或钢板固定，记录病人手术时间、术中出血量、骨折愈合时间及并发症发生情况，并依照美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足功能评分系统与疼痛视觉模拟量表（visual analogue scale，VAS）评估效果。结果 病人手术时间为（117.34±26.57） min，术中出血量为（78.94±15.21） mL。病人均获得随访，随访时间为（16.81±2.45）个月，术后骨性愈合时间为（6.26±1.29）个月，术后1周、6、12个月、末次随访的VAS评分与术前比较，差异有统计学意义（P＜0.05）。依据美国足踝外科协会制定的踝关节评定标准评定，优14例，良7例，可2例，优良率为91.30%。2例病人出现切口皮肤表皮坏死，所有病人均未发生切口感染、深静脉血栓及内固定失败等严重并发症。结论 采用后内、后外侧双切口治疗伴Bartonicek Ⅲ型后踝骨块的三踝骨折，能在直视下同时显露、复位与固定后踝骨折块，具有内外兼顾、易于固定、减少皮肤血运干扰等优点。 |
| 英文摘要: |
| Objective To investigate the outcome of dual posterior approaches for cotton fracture with Bartonicek type Ⅲ posterior ankle bone mass. Methods From February 2016 to January 2019, a total of 23 cases of three malleolar fractures with Bartonicek type Ⅲ posterior malleolus fragment treated by open reduction and internal fixation via combined approaches (posterior-lateral and posterior-medial) were analyzed, which including 15 males and 8 females, aged (43.85±14.91) years (19-67 years). The fracture was reduced in the order of lateral malleolus, posterior malleolus and medial malleolus. Lateral malleolar was fixed with locking plate, posterior ankle was fixed with a T-shaped plate or screw according to the size of the bone block, and medial malleolus fracture was fixed with a screw or plate in line with the shape of the fracture line. The operative time, intraoperative bleeding, fracture healing time and complications were recorded, and clinical outcome was evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score. Results The operative time was (117.34±26.57) min. The intraoperative bleeding was (78.94±15.21) mL. All patients were followed up for (16.81±2.45) months. The postoperative bony healing time was (6.26±1.29) months, and there was significant difference in VAS scores before and after operation (P＜0.05) at the 1st week, 6th month, 12th month, and final follow-up. According to the ankle joint assessment criteria established by AOFAS, curative effects were excellent in 14 cases, good in 7 and fair in 2, with an excellent and good rate of 91.30%. Two patients developed epidermal necrosis of the incision skin, and no serious complications such as incision infection, deep vein thrombosis and internal fixation failure occurred in all patients. Conclusion Dual posterior approaches for three malleolar fractures with Bartonicek type Ⅲ posterior malleolus fragment can simultaneously expose, reduce and fix the posterior ankle bone block under direct vision. It possesses the advantages of internal and external consideration, easy fixation and reducing skin blood supply interference. |
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