杨玉起 王金刚 李虎 杨巍巍 陈勇 杨林

摘 要：目的 總结分析三踝骨折骨折的治疗方法、疗效和临床经验，为三踝骨折的外科治疗提供指导。方法 回顾分析我院2015年3月～ 2017年10月采用切开复位+内固定治疗的21例三踝骨折患者，所有患者外踝骨折经踝关节外侧切口复位后腓骨远端解剖锁定钢板固定，后踝和内踝均通过后内侧切口复位，患者术前、术后均行踝关节正侧位摄片检查，末次随访时根据美国足踝外科协会（AOFAS）足踝评分系统对踝关节功能进行疗效评定。结果 5例患者存在下胫腓联合损伤并均采用下胫腓螺钉固定。21例患者均获得骨折愈合，骨折愈合时间12～16周，平均骨折愈合时间（13.82±3.56）周。AOFAS足踝得分70～97分，平均AOFAS足踝得分为（90.70±6.78）分，其中优12例，良8例，可1例，无感染、骨不连、骨折畸形愈合、内固定松动等并发症。结论 三踝骨折患者经外侧入路结合后内测入路切开复位内固定治疗可以获得满意的临床疗效。

关键词：三踝骨折；外侧入路；内测入路；切开复位内固定术

中图分类号：R683.42 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.15.063

文章编号：1006-1959（2018）15-0185-03

Clinical Analysis of Surgical Treatment of Trimalleolar Fractures

YANG Yu-qi，WANG Jing-gang，LI Hu，YANG Wei-wei，CHEN Yong，YANG Lin

（Department of Orthopaedics，Funan County of Traditional Chinese Medicine Hospital，Funan 226300，Anhui，China）

Abstract：Objective To summarize and analyze the treatment， curative effect and clinical experience of trimalleolar fracture，and to provide guidance for surgical treatment of trimalleolar fracture.Methods 21 cases of trimalleolar fractures treated by open reduction+ internal fixation in our hospital from March 2015 to October 2017 were retrospectively analyzed.The lateral malleolus fractures of all patients were fixed by lateral ankle incision，and the distal fibular fractures were fixed with anatomical locking plates.The posterior malleolus and the medial malleolus were repositioned through the posterior medial incision.The patients were examined before and after the operation，and the ankle joint function was evaluated according to the American Ankle Surgery Association（AOFAS）foot and ankle scoring system at the last follow-up.Results 5 patients had lower tibiofibular joint injuries and were treated with lower tibiofibular screw fixation.Fracture healing was achieved in all 21 patients.The healing time was 12 to16 weeks，and the average healing time was（13.82±3.56）weeks.The score of AOFAS foot and ankle was 70 to 97.The average score of AOFAS foot and ankle was （90.70±6.78）points，of which 12 cases were excellent，8 cases were good，1 case was average，no infection，bone nonunion，fracture malunion，internal fixation loosening and so on.Conclusion The treatment of trimalleolar fracture with open reduction and internal fixation through lateral approach combined with posterior internal measurement approach can achieve satisfactory clinical results.

Key words：Trimalleolar fracture；Lateral approach；Internal approach；Open reduction and internal fixation

三踝骨折是踝关节骨折中较为复杂的一类，往往由于高能量损伤所致，并且常常伴有韧带的撕裂，导致踝关节的不稳定。保守治疗后踝关节不稳、创伤性关节炎等并发症较多，因此目前多主张手术切开复位内固定治疗。现选取2015年3月～2017年10月我院采用切开复位+内固定治疗21例三踝骨折患者，观察治疗效果，报道如下。

1资料与方法

1.1一般资料 2015年3月～2017年10月安徽省阜南县中医院共收治三踝骨折患者21例，其中男性14例，女性7例，左侧12例，右侧9例，年龄34～70岁，平均年龄（40±13.48）岁，均为新鲜闭合性骨折。……