摘要目的 观察改良后外侧入路锁定钢板治疗外踝后踝骨折的疗效. 方法 回顾性分析温州医科大学附属第二医院创伤骨科自2015年1月至2018年1月收治的25例累及外踝后踝骨折的患者资料,男13例,女12例;年龄18 ～70岁,平均43.1岁;踝关节损伤根据Lauge-Hansen分型:旋后外旋型Ⅲ度9例,旋后外旋型Ⅳ度11例,旋前外旋型Ⅳ度5例;合并踝关节脱位6例.后踝骨折根据Haraguchi分型全部为Ⅰ型骨折.均采用改良后外侧入路锁定钢板内固定外踝后踝.观察记录手术时间、骨折愈合时间以及术后并发症发生情况,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. 结果 本组患者手术时间50～100 min,平均70 min.21例患者术后获12～18个月(平均14个月)随访.术后3～5个月均骨性愈合.3例患者出现创口浅表感染,无术后粘连、深部感染,无长屈肌腱挛缩畸形、内固定松动、断裂等不良情况发生.末次随访时采用AOFAS的踝-后足评分评定疗效:优13例,良6例,可2例.结论 改良后外侧入路可以同一切口解决后踝及外踝骨折,避免剥离长屈肌起点,减少了长屈肌术后粘连,值得推广.

abstractsObjective To observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures.Methods From January 2015 to January 2018,25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics,The Second Affiliated Hospital to Wenzhou Medical University.They were 13 males and 12 females,aged from 18 to 70 years (mean,43.1 years).By the Lauge-Hansen classification for ankle injury,9 cases belonged to supination-supination type of degree Ⅲ,11 to supination-supination type of degree Ⅳ,and 5 to pronation-supination type of degree Ⅳ.By the Haraguchi classification,all the posterior malleolar fractures in this series belonged to type Ⅰ.Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures.Their operation time,fracture healing time and postoperative complications were observed.At the last follow-up,ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results In the 25 patients,the operation time ranged from 50 to 100 min (mean,70 min).Of this group,21 patients were followed up for 12 to 18 months (mean,14 months).Bony union was achieved after 3 to 5 months after operation.Superficial wound infection was observed in 3 cases.No such complications occurred like postoperative adhesion,deep infection,contracture of flexor hallucis longus tendon,or loosening or breakage of implants.By the AOFAS ankle-hindfoot scale at the last follow-up,the ankle function was excellent in 13 cases,good in 6 and fair in 2.Conclusion The modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision,not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus.