李锋

[摘要] 目的 探討踝关节后外侧入路联合内侧入路内固定治疗三踝骨折的疗效与安全性。方法 方便选取2015年9月—2019年3月该院收治的80例三踝骨折患者为研究对象，依据治疗方法分为实验组（采用改良踝关节后外侧入路联合内侧入路内固定治疗，40例）和对照组（采用常规踝关节外侧入路联合内侧入路内固定治疗，40例），对比分析两组患者术中出血量、手术时间、骨折愈合时间以及踝关节功能恢复优良率等情况。结果 实验组患者术中出血量明显少于对照组，差异有统计学意义（t=9.398，P<0.05），实验组患者手术时间、骨折愈合时间等均明显短于对照组，差异有统计学意义（t=8.601、4.687，P<0.05）。实验组患者踝关节功能恢复优良38例，对照组患者踝关节功能恢复优良33例，实验组患者踝关节功能恢复优良率95.0%显著高于对照组82.5%，差异有统计学意义（χ2=4.701，P<0.05）。结论 踝关节后外侧入路联合内侧入路内固定治疗三踝骨折的疗效良好，有利于促进患者骨折尽早愈合，值得在临床上广泛推广应用。

[关键词] 三踝骨折;后外侧入路;内侧入路内固定

[中图分类号] R683          [文献标识码] A          [文章编号] 1674-0742（2019）11（a）-0067-03

Clinical Analysis of Posterior Lateral Approach Combined with Medial Approach for the Treatment of Trigeminal Fracture

LI Feng

Department of Orthopaedics， Huishan District Hospital of Wuxi， Wuxi， Jiangsu Province， 214177 China

[Abstract] Objective To evaluate the efficacy and safety of posterior lateral approach of the ankle joint combined with medial approach for the treatment of trigeminal fractures. Methods Eighty patients with tricuspid fractures admitted to our hospital from September 2015 to March 2019 were Conveniently selected into the study. They were divided into experimental group （the modified posterior lateral approach combined with medial approach internal fixation， 40 cases） and the control group （conventional ankle lateral approach combined with medial approach internal fixation， 40 cases） according to the treatment method， comparative analysis of the intraoperative blood loss， operation time， fracture healing time and ankle function recovery rate. Results The intraoperative blood loss of the experimental group was significantly lower than that of the control group （t=9.398， P<0.05）. The operation time and fracture healing time of the experimental group were significantly shorter than the control group （t=8.601， 4.687， P<0.05）. In the experimental group， 38 patients had excellent ankle function recovery， and the control group had excellent ankle function recovery in 33 cases. The excellent rate of ankle joint function recovery in the experimental group was 95.0% higher than that in the control group 82.5%（χ2=4.701， P<0.05）. Conclusion The posterior lateral approach of the ankle joint combined with the medial approach for the treatment of trigeminal fractures is effective， which is conducive to the early healing of fractures. It is worthy of widespread application in clinical practice.

[Key words] Three jaw fracture; Posterolateral approach; Medial approach

踝关节骨折是一种常见的骨科疾病，三踝骨折患者病情较为严重，主要指的是内外踝及后踝同时出现骨裂或骨折[1]。一旦出现三踝骨折会大大影响踝关节灵活性、稳定性，也会降低踝关节功能甚至丧失[2]。目前，临床主要采用手术方式治疗，手术方式包括前入路、后内侧入路以及后外侧入路等方式，不管采用什么手术方式，最关键的还是解剖复位内固定[3]。后踝骨折的位置比较深，且其周围生理解剖结构较复杂，手术治疗效果一般，如果入路方式没有充分暴露骨折部位很容易损伤骨折周围软组织，甚至可能会导致重要血管神经受损，术后也容易引发一系列并发症[4]。为探讨踝关节后外侧入路联合内侧入路内固定治疗三踝骨折的疗效与安全性，该文对比分析了2015年9月—2019年3月该院收治的80例三踝骨折患者分别采用常规踝关节外侧入路联合内侧入路内固定治疗以及改良踝关节后外侧入路联合内侧入路内固定治疗的临床效果，现报道如下。……