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安庆市第一人民医院骨一科,安徽 安庆 246000
纸质出版日期:2024-03-25,
收稿日期:2023-02-24,
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张先启,余正友,林四龙.后踝内侧垂直联合线后前入路治疗后踝骨折的临床研究[J].局解手术学杂志,2024,33(03):272-275.
ZHANG Xian-qi,YU Zheng-you,LIN Si-long.Clinical study of posterior to anterior approach with posteromedial vertical syndesmotic line in treatment of posterior malleolus fractures[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(03):272-275.
张先启,余正友,林四龙.后踝内侧垂直联合线后前入路治疗后踝骨折的临床研究[J].局解手术学杂志,2024,33(03):272-275. DOI: 10.11659/jjssx.02E023129.
ZHANG Xian-qi,YU Zheng-you,LIN Si-long.Clinical study of posterior to anterior approach with posteromedial vertical syndesmotic line in treatment of posterior malleolus fractures[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(03):272-275. DOI: 10.11659/jjssx.02E023129.
目的
2
探讨参考后踝内侧垂直联合线(PVSL)行闭合复位经皮后前(PA)入路空心拉力螺钉内固定治疗后踝骨折的临床效果。
方法
2
选择2020年1月至2022年1月于我院后踝骨折患者23例,均参考PVSL行闭合复位经皮PA入路空心拉力螺钉内固定治疗。记录患者术后骨折复位、踝关节功能恢复、并发症发生及恢复情况。
结果
2
23例患者术后获得6~20个月的随访。术后所有患者后踝骨折块均得到良好复位,移位均小于2 mm。X射线显示,患者骨折均全部愈合,骨折愈合时间3~6个月。美国足踝外科协会(AOFAS)踝-后足评分为76~100分,平均(89.8±8.2)分;术后踝关节功能优17例、良5例、中1例,优良率为95.7%。所有患者均未发生螺钉松动、断裂等并发症。
结论
2
参考PVSL闭合复位经皮PA入路空心拉力螺钉内固定治疗后踝骨折手术效果显著,值得临床推广应用。
Objective
2
To explore the clinical effect of closed reduction and internal fixation with percutaneous cannulated screws through posterior to anterior (PA) approach with reference to posteromedial vertical syndesmotic line (PVSL) for the treatment of posterior malleolus fractures.
Methods
2
A total of 23 patients with posterior malleolus fractures in our hospital from January 2020 to January 2022 were slected, and received closed reduction and internal fixation with percutaneous cannulated screws through PA approach with reference to PVSL. The fracture reduction, functional recovery of ankle joint, occurrence of complications, and rehabilitation of patients after surgery were recorded.
Results
2
After surgery, 23 patients were followed up for 6 to 20 months.After surgery, the posterior malleolar fracture fragments of all patients were of good reduction, with the displacement less than 2 mm.The X-ray showed that all fractures healed, with the fracture healing time of 3 to 6 months. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores ranged from 76 to 100 points, with an average of (89.8±8.2) points; the ankle joint function was excellent in 17 cases, good in 5 cases, and moderate in 1 case, with an excellent and good rate of 95.7%. No complications such as screw loosening or breakage occurred in all cases.
Conclusion
2
The closed reduction and internal fixation with percutaneous cannulated screws through PA approach with reference to PVSL has a significant surgical effect for posterior malleolus fractures,which is worthy of clinical promotion and application.
后踝骨折内固定术后踝内侧垂直联合线前后入路后前入路
posterior malleolus fractureinternal fixationposteromedial vertical syndesmotic lineanterior to posterior approachposterior to anterior approach
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Bartoníček J, Rammelt S, Tuček M. Posterior malleolar fractures: changing concepts and recent developments[J]. Foot Ankle Clin,2017,22(1):125-145. doi:10.1016/j.fcl.2016.09.009http://dx.doi.org/10.1016/j.fcl.2016.09.009.
Czerwonka N, Momenzadeh K, Stenquist DS, et al. Anatomic structures at risk during posterior to anterior percutaneous screw fixation of posterior malleolar fractures: a cadaveric study[J]. Foot Ankle Spec,2022,15(1):50-58. doi:10.1177/1938640020943004http://dx.doi.org/10.1177/1938640020943004.
Caroline W, Kaveh M, Max M, et al. Anatomic and radiographic safe zone for posterior malleolar screw placement[J]. Foot Ankle Int,2021,42(12):1598-1605. doi:10.1177/10711007211022747http://dx.doi.org/10.1177/10711007211022747.
Baumbach SF, Herterich V, Damblemont A, et al. Open reduction and internal fixation of the posterior malleolusfragment frequently restores syndesmotic stability[J]. Injury, 2019, 50(2): 564-570. doi:10.1016/j.injury.2018.12.025http://dx.doi.org/10.1016/j.injury.2018.12.025.
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Levack AE,Warner SJ,Gausden EB,et al. Comparing functional outcomes after injury-specific fixation of posterior malleolar fractures and equivalent ligamentous injuries in rotational ankle fractures[J]. J Orthop Trauma,2018,32(4):e123-e128.
Shi HF, Xiong J, Chen YX, et al. Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures[J]. BMC Musculoskelet Disord,2017,18(1):109. doi:10.1186/s12891-017-1475-7http://dx.doi.org/10.1186/s12891-017-1475-7.
吴浩俊,何艳霞,陈航,等.前后螺钉和后前螺钉治疗后踝骨折患者效果比较[J].中国综合临床,2020,36(1):61-65.doi:10.3760/cma.j.issn.1008-6315.2020.01.014http://dx.doi.org/10.3760/cma.j.issn.1008-6315.2020.01.014.
Gonzalez TA, Watkins C, Drummond R, et al. Transfibular approach to posterior malleolus fracture fixation: technique tip[J]. Foot Ankle Int, 2015, 37(4): 440-445. doi:10.1177/1071100715617760http://dx.doi.org/10.1177/1071100715617760.
Verhage SM, Krijnen P, Schipper IB, et al. Persistent postoperative step-off of the posterior malleolus leads to higher incidence of post- traumatic osteoarthritis in trimalleolar fractures[J]. Arch Orthop Trauma Surg, 2019, 139(3): 323-329.doi:10.1007/s00402-018-3056-0http://dx.doi.org/10.1007/s00402-018-3056-0.
Odak S, Ahluwalia R, Unnikrishnan P,et al. Management of posterior malleolar fractures: a systematic review[J]. J Foot Ankle Surg,2016,55(1):140-145. doi:10.1053/j.jfas.2015.04.001http://dx.doi.org/10.1053/j.jfas.2015.04.001.
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