摘要
[目的]比较改良与常规后外侧入路开放复位内固定治疗三踝骨折的临床疗效。[方法]回顾分析2015年9月—2023年4月开放复位内固定治疗三踝骨折的84例患者资料。根据术前医患沟通结果,43例采用改良后外侧入路(改良组),另外41例采用常规后外侧入路(常规组)。对比两组围手术期、随访与影像指标。[结果]改良组手术时间[min,(100.5±12.9)vs(115.3±7.5),P<0.001]、切口长度[cm,(10.0±1.3)vs(11.0±1.8),P=0.004]、术中失血量[mL,(111.3±18.0)vs(132.7±11.5),P<0.001]均显著优于常规组。两组下地行走时间、切口愈合等级、住院时间、早期并发症的差异无统计学意义(P>0.05)。随时间推移,两组VAS评分、AOFAS评分、背伸-跖屈ROM均显著改善(P<0.05)。术后1个月,改良组的VAS评分[分,(2.1±1.4)vs(3.0±1.5),P=0.006]、AOFAS评分[分,(60.7±5.0)vs(56.4±5.5),P<0.001]和背伸-跖屈ROM[°,(10.5±1.8)vs(9.6±2.0),P=0.033]均显著优于常规组。随访期间,改良组不良事件发生率显著低于常规组(9.3%vs 26.8%,P=0.036)。影像检查表明,改良组术后即刻后踝骨折块移位显著小于常规组[mm,(0.6±0.4)vs(0.8±0.5),P=0.046],相应时间点两组间其他影像指标的差异均无统计学意义(P>0.05)。[结论]改良与常规后外侧入路开放复位内固定三踝骨折的远期疗效相当,但改良入路在减轻患者术后早期疼痛、改善功能以及降低随访不良事件方面明显优于常规后外侧入路。
[Objective]To compare the clinical efficacy of the modified posterolateral approach versus conventional counterpart for open reduction and internal fixation(ORIF)of trimalleolar ankle fractures.[Method]A retrospective study was conducted on 84 patients who received ORIF for the trimalleolar ankle fractures from September 2015 to April 2023.According to preoperative doctor-patient com⁃munication,43 patients had ORIF performed through the modified posterolateral approach(the modified group),while the other 41 patients were through the conventional posterolateral approach(the conventional group).The perioperative,follow-up,and imaging parameters of the two groups were compared.[Results]The modified group proved significantly superior to the conventional group in terms of operation time[min,(100.5±12.9)vs(115.3±7.5),P<0.001],incision length[cm,(10.0±1.3)vs(11.0±1.8),P=0.004],and intraoperative blood loss[mL,(111.3±18.0)vs(132.7±11.5),P<0.001].However,there were no statistically significant differences in the time to ambulation,incision healing grade,hospital stay,and early complications between the two groups(P>0.05).The VAS score,AOFAS score,and dorsiflexion-plantarflexion ROM in both groups significantly improved over time(P<0.05).The modified group was significantly better over the conven⁃tional group regarding the VAS score[points,(2.1±1.4)vs(3.0±1.5),P=0.006],AOFAS score[points,(60.7±5.0)vs(56.4±5.5),P<0.001],and dorsiflexion-plantarflexion ROM[°,(10.5±1.8)vs(9.6±2.0),P=0.033]one month postoperatively.During the follow-up period,the inci⁃dence of adverse events in the modified group was significantly lower than that in the conventional group(9.3%vs 26.8%,P=0.036).With respect of imaging,the modified group had significantly less displacement of the posterior malleolus fracture fragments immediately after surgery than the conventional group[mm,(0.6±0.4)vs(0.8±0.5),P=0.046],although there were no statistically significant differences in oth⁃er imaging indicators between the two groups at any corresponding time points(P>0.05).[Conclusion]The modified posterolateral ap⁃proach for ORIF of trimalleolar ankle fractures achieves comparable long-term clinical consequence to the conventional counterpart,but the modified approach significantly reduces postoperative early pain and improves function and reduces follow-up adverse events over the conventional posterolateral approach.
作者
王新国
曹华
郭强
程慧
李安澜
WANG Xing-guo;CAO Hua;GUO Qiang;CHENG Hui;LI An-lan(Department of Orthopedics,Zhenjiang 359 Hospital,Zhenjiang 212001,Jiangsu,China)
出处
《中国矫形外科杂志》
北大核心
2026年第4期319-324,共6页
Orthopedic Journal of China
关键词
踝关节
三踝骨折
开放复位内固定
改良后外侧入路
常规后外侧入路
ankle
trimalleolar ankle fractures
open reduction and internal fixation
modified posterolateral approach
conventional posterolateral approach
