两种手术入路治疗旋后-外旋型踝关节骨折的比较。

Comparison of Two Surgical Approaches to Supination-External Rotation-Type Ankle Fractures.

机构信息

Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples' Hospital of Changshu City, Changshu 215500, Jiangsu, China.

出版信息

J Healthc Eng. 2022 Apr 11;2022:7726726. doi: 10.1155/2022/7726726. eCollection 2022.

DOI:10.1155/2022/7726726

PMID:35444779

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9015882/

Abstract

OBJECTIVE

To compare the clinical outcome and postoperative complications of the treatment of supination-external rotation-type ankle fractures using the posterolateral approach in the prone position and the lateral approach in the supine position.

METHODS

A retrospective cohort study was conducted in our hospital, including a total of 66 patients ranging from January 2013 to February 2016, regardless of age or sex. All the patients were classified as Lauge-Hansen supination-external rotation (SER)-type ankle fractures and were assigned to receive an open reduction and internal fixation (ORIF) through a posterolateral approach performed in the prone position (the "posterolateral approach group," 32 patients), or a lateral approach performed in the supine position (the "Lateral Approach Group," 34 patients). In the posterolateral approach group, 5 patients had Grade II fractures, 8 had Grade III fractures, and 19 had Grade IV fractures; among whom, 12 underwent fixation of the posterior malleolus with hollow screws and 6 with plates, and none of them had fixation of the distal tibiofibular syndesmosis; in the lateral approach group, 4 patients had Grade II fractures, 12 had Grade III fractures, and 18 had Grade IV fractures; among whom, 21 received fixation of the posterior malleolus, and 5 received fixation of the distal tibiofibular syndesmosis. The postoperative complications and ankle scores were recorded.

RESULTS

After 1 year of follow-up, in the posterolateral approach group, the incision healed by primary intention and sutures were removed 2 weeks after the operation in all patients; 1 patient had pain in the region posterior to the fibula, presumably peroneal tendon irritation induced by internal fixation, which disappeared after fracture union and fixation device removal; no loosening or breakage of the internal fixation device was reported; the rate of good to excellent results was 96.8% at 12 months. In the lateral approach group: 1 case of wound infection, 1 case of necrosis of lateral skin flap, and 3 cases of lateral skin irritation were reported; the rate of good to excellent results was 94.6% at 12 months.

CONCLUSION

Compared with the traditional lateral approach, the posterolateral approach for the reduction and internal fixation of supination-external rotation-type ankle fractures performed in the prone position has more satisfactory clinical outcomes, with better reduction, more secure fixation, and smaller wound.

摘要

目的

比较俯卧位后外侧入路与仰卧位外侧入路治疗旋后外旋型踝关节骨折的临床疗效及术后并发症。

方法

回顾性分析我院 2013 年 1 月至 2016 年 2 月收治的 66 例旋后外旋型踝关节骨折患者，其中男 35 例，女 31 例；年龄 18～62 岁，平均 36.6 岁。均为旋后外旋（Lauge-Hansen）Lange-Hansen 分型，按手术方法分为后外侧入路组（俯卧位，32 例）和外侧入路组（仰卧位，34 例）。后外侧入路组：男 18 例，女 14 例；年龄 18～62 岁，平均 36.5 岁。Lauge-Hansen 分型：Ⅱ型 5 例，Ⅲ型 8 例，Ⅳ型 19 例。手术采用后外侧入路，腓骨后缘小切口，暴露后踝及下胫腓联合，空心钉或钢板固定后踝，不固定下胫腓联合。外侧入路组：男 17 例，女 17 例；年龄 18～62 岁，平均 36.7 岁。Lauge-Hansen 分型：Ⅱ型 4 例，Ⅲ型 12 例，Ⅳ型 18 例。手术采用外侧入路，常规显露外踝及下胫腓联合，螺钉或钢板固定后踝及下胫腓联合。比较两组患者的手术时间、术中出血量、术后并发症、末次随访时的踝关节 AOFAS 评分及骨折愈合时间。

结果

两组患者均获得随访，随访时间 12～36 个月，平均 20.3 个月。两组患者的手术时间、术中出血量及骨折愈合时间比较差异均无统计学意义（P＞0.05）。后外侧入路组术后切口均一期愈合，所有患者术后 2 周拆线；1 例患者术后出现腓骨后缘疼痛，考虑为内固定物刺激腓骨肌腱，骨折愈合、内固定物取出后疼痛消失；无内固定物松动、断裂；末次随访时 AOFAS 评分为优 29 例，良 2 例，可 1 例，优良率为 96.8%。外侧入路组：术后发生切口感染 1 例，皮瓣坏死 1 例，皮肤刺激 3 例；末次随访时 AOFAS 评分为优 29 例，良 3 例，可 2 例，优良率为 94.6%。