Lee Hyo-Jin, Kim Sung Jae, Park Young Uk, Hyun Jintak, Kim Hyong Nyun
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Orthopedic Surgery, 366256Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
J Orthop Surg (Hong Kong). 2021 Sep-Dec;29(3):23094990211055867. doi: 10.1177/23094990211055867.
We describe a novel technique that uses an aiming drill guide and ankle arthroscopy for direct visualization and reduction of the depressed articular surface located between the posterior tibia and the fractured posterior malleolus. This technique requires less soft tissue dissection to visualize and reduce the depressed articular surface.
Between June 2014 and May 2019, 126 patients were surgically treated for trimalleolar fractures. Among them, 11 had depressed articular fragment between the posterior tibia and the fractured posterior malleolus reduced using our novel technique. The study included six men and five women, with a mean age of 46.5 (range: 23-62) years.
In eight (73%) cases, the articular surface was reduced, with the articular surface step-off being less than 2 mm, as noted on postoperative computed tomography (CT). Syndesmosis congruity within an anterior-to-posterior difference of less than 2 mm was confirmed in nine (82%) cases via postoperative CT. The mean 100-mm visual analog scale (VAS) and the mean Olerud-Molander ankle score at the final follow-up were 16.6 ± 14.5 and 87.7 ± 7.5, respectively.
The depressed articular fragment located between the posterior tibia and the fractured posterior malleolus can be treated using an aiming drill guide and ankle arthroscopy. Ankle arthroscopy is used for direct visualization of the depressed articular surface, and the aiming drill guide can guide the bone plunger precisely to the depressed articular surface for reduction. This technique requires less soft tissue dissection than conventional techniques to visualize and reduce the depressed articular surface.
我们描述了一种新技术，该技术使用瞄准钻导向器和踝关节镜来直接可视化并复位位于胫骨后缘与后踝骨折之间的凹陷关节面。该技术在可视化和复位凹陷关节面时所需的软组织分离较少。
在2014年6月至2019年5月期间，126例患者接受了三踝骨折的手术治疗。其中，11例使用我们的新技术复位了胫骨后缘与后踝骨折之间的凹陷关节碎片。该研究纳入了6名男性和5名女性，平均年龄为46.5岁（范围：23 - 62岁）。
术后计算机断层扫描（CT）显示，8例（73%）患者的关节面得到复位，关节面台阶小于2毫米。术后CT证实，9例（82%）患者的下胫腓联合前后差异小于2毫米时对位良好。末次随访时，平均100毫米视觉模拟量表（VAS）评分和平均Olerud - Molander踝关节评分分别为16.6±14.5和87.7±7.5。
位于胫骨后缘与后踝骨折之间的凹陷关节碎片可使用瞄准钻导向器和踝关节镜进行治疗。踝关节镜用于直接观察凹陷关节面，瞄准钻导向器可将骨栓精确引导至凹陷关节面进行复位。与传统技术相比，该技术在可视化和复位凹陷关节面时所需的软组织分离更少。
