Bartoníček Jan, Rammelt Stefan, Tuček Michal
Department of Orthopaedics, First Faculty of Medicine, Central Military Hospital Prague, Charles University, U Vojenské Nemocnice 1200, Prague 6 169 02, Czech Republic; Department of Anatomy, First Faculty of Medicine, Charles University Prague, U Nemocnice 3, Prague 2 120 00, Czech Republic.
University Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
Foot Ankle Clin. 2017 Mar;22(1):125-145. doi: 10.1016/j.fcl.2016.09.009. Epub 2016 Dec 20.
Injuries to the posterior malleolus are of prognostic relevance in ankle fracture-dislocations. The three-dimensional outline of the fragments as reflected by computed tomography classification, involvement of the fibular notch, and the presence of intercalary fragments seem to be of greater therapeutic relevance than the size of the fragment and amount of the articular surface involved. Operative treatment aims at reconstruction of the posterior tibial plafond, the fibular notch, and the integrity of the posterior inferior tibiofibular syndesmosis. Direct open reduction and fixation of posterior malleolus fragments via posterior approaches is biomechanically more stable than indirect reduction and anteroposterior screw fixation.
后踝损伤在踝关节骨折脱位中具有预后相关性。计算机断层扫描分类所反映的骨折块三维轮廓、腓骨切迹受累情况以及间插骨折块的存在，似乎比骨折块大小和关节面受累程度具有更大的治疗相关性。手术治疗旨在重建胫后平台、腓骨切迹以及胫腓后下联合的完整性。通过后侧入路对后踝骨折块进行直接切开复位内固定在生物力学上比间接复位和前后螺钉固定更稳定。
