目的 比较经后外侧入路由后向前三枚空心螺钉三角分布固定与钢板固定治疗累及关节面≥25%后踝骨折的临床疗效.方法 回顾性分析南京大学医学院附属苏州医院2016年5月至2022年5月行外科手术治疗的63例后踝骨折患者的临床资料,其中33例行三枚空心螺钉三角分布固定(空心钉组),30例行钢板固定(钢板组).比较两组患者的术中出血量、手术时间、骨折愈合时间、并发症发生率,以及术后6、12个月及末次随访时踝关节功能评分(American Orthopaedic Foot and Ankle Society,AOFAS)和踝关节活动度(range of motion,ROM).结果 63例患者均得到随访,随访时间为12~48个月,平均(20.5±2.1)个月.两组患者在平均手术时间及并发症发生率方面比较,差异有统计学意义(P<0.05),平均手术时间空心钉组短于钢板组,并发症发生率空心钉组(3.03%)低于钢板组(13.33%);而两组患者的术中出血量及后踝骨折愈合时间比较,差异无统计学意义(P>0.05).末次随访时优良率比较,空心钉组(90.9%)与钢板组(90.0%)差异无统计学意义(P>0.05).两组患者随访期间均未出现切口感染、内固定物松动、退出、骨不连等并发症.结论 两种方法在治疗此类后踝骨折中均可取得良好的临床疗效,而空心螺钉三角分布固定具有创伤小、并发症少及易于取出等众多优点,是此类后踝骨折内固定有效且经济的方法选择.
Objective To compare the clinical outcomes of posterior lateral approach with triangular distribution fixation of three lag screws and plate fixation in the treatment of posterior malleolar fractures involving≥25%of the distal tibial articular surface in ankle fractures.Methods A retrospective case control study was performed on the clinical data of 63 patients with posterior malleolar fractures from May 2016 to May 2022 in Suzhou Hospital,Affiliated Hospital of Medical School,Nanjing University.They received posterior malleolus fixation with three lag screws(lag screw group,33 cases)and with a plate(plate group,30 cases).The intraoperative bleeding volume,operating time,fracture healing time,and incidence of postoperative complications for two groups of patients were recorded.At 6 and 12 months postoperatively and at the final follow-up,the ankle motion was evaluated using American Orthopaedic Foot and Ankle Society(AOFAS)and range of motion(ROM).Results The follow-up time of the two groups was 12-48 months,with an average of(20.5±2.1)months.The two groups have significant difference in the average operating time and incidence of postoperative complications(P<0.05),the average operating time of lag screw group was shorter than that of plate group,and the incidence of postoperative complications in the lag screw group(3.03%)was lower than that of plate group(13.33%).However,there was no significant difference in the average intraoperative bleeding volume and healing time of posterior malleolar fracture between the two groups(P>0.05).There was no significant difference in the excellent and good rate between the lag screw group(90.9%)and plate group(90.0%)at the last follow-up(P>0.05).Also,there was no postoperative complications such as incision infection,loosening of internal fixation,withdrawal,or bone non-union observed between the two groups of patients during follow-up.Conclusion There are no significant differences between lag screw triangular distribution fixation and plate fixation in AOFAS score and ROM of the ankle after fixation for posterior malleolus fractures involving≥25%of the articular surface,the two fixation methods can both achieve good clinical outcomes.However,fixation for lag screw triangular distribution has many advantages such as less invasive fixation,fewer complications,and easy removal.It is an effective and economical method for internal fixation of this type of posterior ankle fracture.