摘要目的 比较经皮空心螺钉和后侧入路支撑钢板治疗后踝骨折的疗效. 方法 回顾性分析2010年1月至2014年12月167例踝关节骨折累及后踝关节面达25％以上患者的临床资料,根据治疗方法不同分为经皮空心螺钉固定组(空心钉组)和后侧入路支撑钢板固定组(支撑钢板组).空心钉组84例,男47例,女37例;年龄23 ～72岁,平均(49.7±9.1)岁;骨折根据Dennis-Webber分型:B型39例,C型45例.支撑钢板组83例,男38例,女45例;年龄31 ～69岁,平均(52.3±8.3)岁;骨折根据Dennis-Webber分型:B型45例,C型38例.术后6、12个月、末次随访时采用美国足踝外科协会(AOFAS)的踝-后足评分评价踝关节功能,关节活动度(ROM)评估踝关节活动情况. 结果 空心钉组患者平均手术时间[(1.1±0.3)h]较支撑钢板组[(1.6±0.4)h]短,差异有统计学意义(Z=-9.145,P＜ 0.001).两组患者均无骨折不愈合、复位丢失及伤口感染发生.空心钉组有5例患者后踝复位不良,移位超过2 mm;有3例患者螺钉位置不佳,各有1枚螺钉穿入下胫腓联合.支撑钢板组有4例患者术后出现足趾屈曲挛缩,7例患者自觉踝关节活动时有不适感.末次随访时两组患者均无明显踝关节创伤后骨关节炎发生.术后6、12个月及末次随访时两组患者的AOFAS踝-后足评分比较差异均无统计学意义(P＞ 0.05),所有患者末次随访时的AOFAS踝-后足评分分别与术后6、12个月比较差异均有统计学意义(P＜0.05);末次随访时两组患者间踝关节的背屈、跖屈、内翻、外翻ROM比较差异均无统计学意义(P＞0.05). 结论 两种方式治疗后踝骨折均能取得良好的临床疗效.经皮空心螺钉固定可间接复位、微创,但复位质量不确定;而支撑钢板固定可直视下解剖复位,但创伤相对较大.

abstractsObjective To compare the clinical outcomes of percutaneous cannulated lag screws versus posterior buttress plate in the fixation for posterior malleolar fractures.Methods We reviewed the 167 patients who had been treated between January 2010 and December 2014 for ankle fracture involving larger than 25％ of the articular surface of the posterior malleolus.They received posterior malleolus fixation with percutaneous cannulated lag screws or with a buttress plate.In the cannulated screw group (84 patients),there were 47 males and 37 females,aged from 23 to 72 years (average,49.7 ±9.1 years),and 39 cases of type B and 45 ones of type C according to the Dennis-Webber classification.In the buttress plate group (83 patients),there were 38 males and 45 females,aged from 31 to 69 years (average,52.3 ± 8.3 years),and 45 cases of type B and 38 ones of type C according to the Dennis-Webber classification.At 6 and 12 months postoperation and the final follow-up,the ankle motion was evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score and range of motion (ROM).Results The average operation time for the cannulated screw group was significantly shorter than for the buttress plate group (Z =-9.145,P ＜ 0.001).No fracture nonunion,reduction loss or incision infection happened in either group.In the cannulated screw group,we detected malunion with a step-off beyond 2 mm in 5 patients,and penetration of one cannulated lag screw into the tibiofibular syndesmosis in 3 patients.In the buttress plate group,we detected toe flexion contracture in 4 patients,and uncomfortable feeling in ankle motion in 7 patients.At the final follow-up,X-rays and CT scans in the 2 groups showed no obvious post-traumatic osteoarthritis of the ankle.There were no significant differences between the 2 groups regarding the AOFAS scores at 6 and 12 months postoperation and the final follow-up(P ＞ 0.05);the AOFAS scores at the final follow-up for all the patients were significantly different from those at 6 and 12 months postoperation (P ＜ 0.05).At the final follow-up,there were no significant differences between the 2 groups regarding ROMs of dorsal flexion,plantar flexion,varus or valgus (P ＞ 0.05).Conclusions As there are no significant differences between the percutaneous cannulated lag screws and posterior buttress plate in AOFAS score and ROM of the ankle after fixation for posterior malleolar fractures,the 2 fixation methods can both achieve good clinical outcomes.Fixation with cannulated lag screws has advantages of indirect reduction and minimal invasion but also a disadvantage of uncertain quality of reduction;fixation with buttress plates has an advantage of anatomical reduction under direct vision but also shortcomings of relatively large invasion and high cost.