Pan Zijie, Cui Xiang, Zhu Yanfeng, Qi Hongzhe, Chen Hua, Tang Peifu
Department of Surgery, No. 522 Military Hospital of Chinese PLA, Luoyang Henan, 471000. P. R. China.
Department of Orthopedics, General Hospital of Chinese PLA.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Dec 8;30(12):1488-1492. doi: 10.7507/1002-1892.20160308.
To evaluate the advantage of single posterolateral approach for exposing the fragments of lateral malleolus and posterior malleolus in treating bimalleolar and trimalleolar fractures.
Between January 2013 and June 2015, 47 patients with ankle fractures were treated. Of 47 cases, 16 were male and 31 were female with an average age of 47.7 years (range, 25-65 years); the locations were the left side in 21 cases and the right side in 26 cases. According to types system of Lauge-Hansen, 11 cases were rated as pronation-external rotation and 36 cases as supination-external rotation. There were 9 cases of bimalleolar fractures and 38 cases trimalleolar fractures. CT examination showed that posterior malleolus fracture involved more than 35% of the joint surface in 11 cases, and 9 cases had comminuted posterior malleolus fracture. Of 47 cases, 44 had fresh fractures with a mean disease course of 4 days (range, 8 hours to 7 days), and 3 had old fracture with the disease course of 43, 58, and 62 days respectively. Posterior malleolus fractures were fixed with T-type plates in 12 cases, one-third tubular plates in 10 cases, and cannulated screws in 25 cases.
The operation time was 60-100 minutes (mean, 80 minutes); the bleeding volume was 50-100 mL (mean, 72 mL). Primary healing of incision was obtained in all patients, and no postoperative complications of infection, cutaneous necrosis, deep venous thrombosis, and sural nerve injury occurred. The CT examinations after operation showed anatomical reduction of fractures. All patients were followed up from 12 to 20 months (mean, 16 months). No fixation failure or reduction loss was found at last follow-up. All patients could walk normally. The active dorsiflexion of the affected ankles was within 5° less than normal side in 43 cases (91.5%) and 5-10° less than normal side in 4 cases (8.5%). The passive dorsiflexion of the affected ankles was within 5° less than normal side in 44 cases (93.6%) and 5-10° less than normal side in 3 cases (6.4%). According to the Olerud-Molander scoring system, the results were excellent in 40 cases, good in 5 cases, and fair in 2 cases; and the excellent and good rate was 95.7% at last follow-up.
The single posterolateral approach could simultaneously expose the fragments of lateral malleolus and posterior malleolus, with less complication of the incision, short operation time, and clear exposure of posterior malleolus. The surgery could be performed under direct vision. It especially is suitable for bimalleolar and trimalleolar fractures with lateral malleolus and posterior malleolus.
评估单后外侧入路在暴露外踝和后踝骨折块以治疗双踝及三踝骨折中的优势。
2013年1月至2015年6月，对47例踝关节骨折患者进行治疗。47例中，男性16例，女性31例，平均年龄47.7岁（范围25 - 65岁）；左侧21例，右侧26例。根据Lauge - Hansen分型系统，旋前外旋型11例，旋后外旋型36例。双踝骨折9例，三踝骨折38例。CT检查显示，11例后踝骨折累及关节面超过35%，9例为粉碎性后踝骨折。47例中，44例为新鲜骨折，平均病程4天（范围8小时至7天），3例为陈旧性骨折，病程分别为43、58和62天。12例后踝骨折用T型钢板固定，10例用三分之一管状钢板固定，25例用空心螺钉固定。
手术时间60 - 100分钟（平均80分钟）；出血量50 - 100 mL（平均72 mL）。所有患者切口均一期愈合，未发生术后感染、皮肤坏死、深静脉血栓形成及腓肠神经损伤等并发症。术后CT检查显示骨折解剖复位。所有患者随访12至20个月（平均16个月）。末次随访时未发现内固定失败或复位丢失。所有患者均能正常行走。患侧踝关节主动背伸较健侧减少5°以内者43例（91.5%），减少5 - 10°者4例（8.5%）。患侧踝关节被动背伸较健侧减少5°以内者44例（93.6%），减少5 - 10°者3例（6.4%）。根据Olerud - Molander评分系统，结果为优40例，良5例，可2例；末次随访时优良率为95.7%。
单后外侧入路可同时暴露外踝和后踝骨折块，切口并发症少，手术时间短，后踝暴露清晰，可在直视下手术，尤其适用于合并外踝和后踝的双踝及三踝骨折。
