摘要目的 探讨65岁及以上老年三踝骨折患者的手术治疗. 方法 三踝骨折患者57例,男25例,女32例;年龄65～81岁,平均71.5岁.根据Lauge-hansen分型,旋后外旋型41例;旋前外旋型16例.外踝骨折采用外踝后方入路,骨折复位后采用普通或锁定钢板固定.后踝骨折采用后外侧入路或经腓骨入路,直视下复位及固定后踝骨折,内踝骨折采用前内侧切口,以内踝的踝穴侧和前侧作为复位标准,采用螺钉或张力带固定.如果下胫腓松弛,固定下胫腓联合. 结果 根据美国足踝外科协会(AOFAS)踝与后足评分标准评价踝关节功能.AOFAS评分为73～95分,平均84.7分,其中优23例、良24例、可7例,优良率87.0％(47/54).3例患者切口处有浅表皮缘坏死,4例切口延迟愈合,浅表切口感染率为12.9％. 结论 手术治疗老年性踝关节骨折,选择合理手术方法及合适的内植物,能够获得满意的疗效,减少并发症的发生.

abstractsObjective To estimate the effect of open reduction and internal fixation for treating the trimalleolar fracture in the elderly.Methods 57 aged patients suffered from the trimalleolar fracture and were treated with internal fixation from January 2009 to June 2012.25 males and 32 females with an average age of 71.5 years ranged from 65 to 81 years were involved in this study.The supination-external rotation type were in 41 cases and pronation-external rotation type in 16 cases according to Lauge-hansen's classification.The posterior and lateral approach was taken for surgical procedure of lateral malleolar frature.The routine or locking plates were used to fix the fratures.The posterior malleolar fractures were usually fixed through the posterolateral approach as well.The screws or tension band fixation was selected for fixing the medial malleolar fragments.The parallel screwing fixation could be helpful for fixing the tibiofibular syndesmosis.Results The ankle function was evaluated by the criteria system of the American Orthopaedic Foot and Ankle Society (AOFAS).The efficacy was excellent in 23 patients,good in 24 patients,fair in 7 patients.The skin problems such as super facial infection and delayed union of incision were in 7 cases.Conclusions If choosing reasonable operation method and suitable internal plant,the open reduction and internal fixation has better effect in treating the trimalleolar fracture in the elderly,with fewer complications.