Objective: To evaluate the advantage of single posterolateral approach for exposing the fragments of lateral malleolus and posterior malleolus in treating bimalleolar and trimalleolar fractures.
Methods: Between January 2013 and June 2015, 47 patients with ankle fractures were treated. Of 47 cases, 16 were male and 31 were female with an average age of 47.7 years (range, 25-65 years); the locations were the left side in 21 cases and the right side in 26 cases. According to types system of Lauge-Hansen, 11 cases were rated as pronation-external rotation and 36 cases as supination-external rotation. There were 9 cases of bimalleolar fractures and 38 cases trimalleolar fractures. CT examination showed that posterior malleolus fracture involved more than 35% of the joint surface in 11 cases, and 9 cases had comminuted posterior malleolus fracture. Of 47 cases, 44 had fresh fractures with a mean disease course of 4 days (range, 8 hours to 7 days), and 3 had old fracture with the disease course of 43, 58, and 62 days respectively. Posterior malleolus fractures were fixed with T-type plates in 12 cases, one-third tubular plates in 10 cases, and cannulated screws in 25 cases.
Results: The operation time was 60-100 minutes (mean, 80 minutes); the bleeding volume was 50-100 mL (mean, 72 mL). Primary healing of incision was obtained in all patients, and no postoperative complications of infection, cutaneous necrosis, deep venous thrombosis, and sural nerve injury occurred. The CT examinations after operation showed anatomical reduction of fractures. All patients were followed up from 12 to 20 months (mean, 16 months). No fixation failure or reduction loss was found at last follow-up. All patients could walk normally. The active dorsiflexion of the affected ankles was within 5° less than normal side in 43 cases (91.5%) and 5-10° less than normal side in 4 cases (8.5%). The passive dorsiflexion of the affected ankles was within 5° less than normal side in 44 cases (93.6%) and 5-10° less than normal side in 3 cases (6.4%). According to the Olerud-Molander scoring system, the results were excellent in 40 cases, good in 5 cases, and fair in 2 cases; and the excellent and good rate was 95.7% at last follow-up.
Conclusions: The single posterolateral approach could simultaneously expose the fragments of lateral malleolus and posterior malleolus, with less complication of the incision, short operation time, and clear exposure of posterior malleolus. The surgery could be performed under direct vision. It especially is suitable for bimalleolar and trimalleolar fractures with lateral malleolus and posterior malleolus.
目的: 探讨采用单一后外侧入路同时显露外踝和后踝骨折块治疗双踝或三踝骨折的疗效。.
方法: 2013年1月-2015年6月，收治47例踝关节骨折患者。男16例，女31例；年龄25～65岁，平均47.7岁。左侧21例，右侧26例。骨折按Lauge-Hansen分型：旋前外展型11例，旋后外旋型36例。双踝骨折9例，三踝骨折38例。CT检查示，后踝骨折块累及35%以上负重关节面11例，后踝粉碎性骨折9例。新鲜骨折44例，受伤至手术时间8 h～7 d，平均4 d；陈旧性骨折3例，受伤至手术时间分别为43、58、62 d。术中后踝骨折采用T型锁定钢板（12例）、1/3管型钢板（10例）或由后向前的空心螺钉（25例）固定。.
结果: 手术时间60～100 min，平均80 min；术中出血量50～100 mL，平均72 mL。术后切口均Ⅰ期愈合，无切口感染、皮肤坏死、下肢深静脉血栓形成及腓肠神经损伤等手术相关并发症发生。术后复查CT显示后踝骨折块均达解剖复位。47例均获随访，随访时间12～20个月，平均16个月。均未发生内固定失效或复位丢失。患者行走正常；踝关节主动背伸活动度较健侧踝关节活动度＜5°者43例（91.5%），5～10°者4例（8.5%）；被动背伸活动度＜5°者44例（93.6%），5～10°者3例（6.4%）。末次随访时，采用Olerud-Molander评分对患者踝关节功能进行评价，其中优40例，良5例，可2例，优良率95.7%。.
结论: 单一后外侧入路能够同时显露外踝和后踝骨折，具有切口并发症少、手术时间短，后踝显露清楚，可直视下完成骨折复位与固定的优势，适合于同时合并外踝和后踝的双踝骨折及三踝骨折。.
Keywords: Ankle joint; Bimalleolar fracture; Posterolateral approach; Trimalleolar fracture.