摘要
目的分析经两切口和三切口行切开复位内固定治疗旋后外旋型Ⅳ度踝关节损伤的临床疗效。方法回顾性分析2021年8月至2023年8月银川市第一人民医院足踝外科收治的72例旋后外旋型Ⅳ度踝关节骨折患者的病例资料,均采用切开复位钢板螺钉内固定治疗,其中43例采用两切口(后外侧切口和内踝内侧切口)、29例采用踝关节三切口(外侧切口、跟腱旁外侧切口及内踝内侧切口)。记录手术时间、术中出血量、骨折愈合时间、术后住院时间,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评价术后12个月的足踝部功能,并观察并发症的发生情况。结果在术后住院时间、住院时间及骨折愈合时间方面,两组间比较差异无统计学意义(P>0.05)。三切口入路组在术中出血量和手术时间上均显著多于两切口入路组(P<0.05);术后12个月患者的AOFAS评分比较,两切口组低于三切口组(t=3.925,P<0.001),差异有统计学意义;两切口组和三切口组患者的并发症发生率比较,差异无统计学意义(P>0.05)。结论经三切口行切开复位内固定术治疗旋后外旋型Ⅳ度踝关节损伤,有利于术后患者踝关节功能的恢复。尤其对于存在后踝夹层骨块或Die-punch骨块、体重偏大者,三切口俯卧位跟腱旁外侧入路对后踝骨折移位及关节面的损伤情况显露清晰,操作简便,可对后踝骨块精确复位并牢固固定,可恢复下胫腓联合的稳定性,安全性高,疗效满意。
Objective To compare the clinical efficacy of dual-incision versus triple-incision approaches for open reduction and internal fixation in managing Lauge-Hansen supination-external rotation stageⅣankle fractures.Methods A retrospective cohort study was conducted on 72 consecutive patients with Lauge-Hansen supination-external rotation stageⅣankle fractures treated at the Foot and Ankle Surgery Center of Yinchuan First People’s Hospital(from August 2021 to August 2023).All patients underwent open reduction and internal fixation using plate-screw constructs,with 43 cases receiving dual-incision approach(posterolateral and medial malleolar)and 29 cases undergoing triple-incision approach(lateral malleolar,lateral para-Achilles,and medial malleolar).Perioperative parameters including operative duration,blood loss,radiographic union time,and postoperative stay were prospectively documented.Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale at 12-month follow-up,with systematic monitoring of complications.Results No statistically significant differences were observed between the cohorts regarding postoperative hospitalization time(P>0.05),hospital stay(P>0.05),or fracture healing time(P>0.05).The triple-incision cohort demonstrated significantly greater intraoperative blood loss(P<0.05)and longer operative time(P<0.05)compared to the dual-incision cohort.The AOFAS scores of patients at 12 months postoperatively were significantly lower in the two-incision group compared to the three-incision group(t=3.925,P<0.001),with a statistically significant difference.No statistically significant difference emerged in complication rates between the two surgical cohorts(P>0.05).Conclusion The three-incision open reduction and internal fixation technique demonstrates enhancedpostoperatⅣe functional recovery in Lauge-Hansensupination-external rotation stageⅣankle injuries.This is particularly critical in cases involving posteriormalleolar split fragments or Die-punch fragments,especially among indⅣiduals with elevated body mass,The lateral para-Achilles approach in prone positioning provides direct visualization of posterior malleolar fracture displacement and articular surface involvement.This approach enables precise reduction and stable fixation of posterior malleolar fragments whilerestoring tibiofibular syndesmotic stability.The technique achieves satisfactoryefficacy with demonstrated procedural safety.
作者
张勇
程连
梁志军
Zhang Yong;Cheng Lian;Liang Zhijun(Second Clinical College of Ningxia Medical University,Ningxia Yinchuan 750000;Third Clinical College of Ningxia Medical University,Ningxia Yinchuan 750000;Orthopedics Department of the First People’s Hospital of Yinchuan,Yinchuan 750000,Ningxia,China)
出处
《足踝外科电子杂志》
2025年第1期11-19,25,共10页
Electronic Journal of Foot and Ankle Surgery
