CAJ | 학술논문

目的：探讨内外侧联合入路治疗内倾型后踝骨折的临床疗效。方法回顾分析2009年3月至2013年3月治疗的117例资料完整的后踝骨折患者，根据术前影像学资料筛选出21例内倾型后踝骨折。男14例，女7例；年龄19~72岁，平均45.2岁；平地扭伤9例，坠落伤7例，车祸伤5例；均为闭合性骨折；均伴腓骨远端骨折及关节软骨面损伤；患者术前均表现为足踝部肿胀、畸形及活动受限。根据 Haraguchi CT 分型：Ⅰ型13例，Ⅱ型5例，Ⅲ型3例；从外伤到手术时间1~12 d，平均5.1 d；采用内外侧联合入路切开复位内固定；术后定期随访切开及骨折愈合情况，并采用 Baird Jackson 评定标准和 SF_36分别评价术后踝关节功能和术后患者生活质量。结果21例患者均获完整随访，时间13~46个月，平均22.3个月。手术时间55~90min，平均（65.7±29.6）min；住院时间5~17d，平均（8.2±1.8）d；术后2 d X 线片显示，解剖复位（胫骨远端关节面无台阶）17例，复位良（有1 mm 台阶）4例，解剖复位率81.0％；切口均一期愈合；骨折愈合时间11~19周，平均14.6周，无骨不连及畸形愈合。末次随访时 Baird Jackson 评分为91~100分，平均95.5分，其中优14例，良7例，优良率100％。SF_36生理评分33.2~66.5分，平均（47.6±5.7）分，SF_36心理评分28.9~66.5分，平均（48.4±4.9）分。结论内倾型后踝骨折采用内外侧联合入路可以获得良好的手术视野，并可直视下复位固定所有骨折块，使之达到解剖复位，从而获得满意临床疗效，是值得推荐的手术入路。
목적：탐토내외측연합입로치료내경형후과골절적림상료효。방법회고분석2009년3월지2013년3월치료적117례자료완정적후과골절환자，근거술전영상학자료사선출21례내경형후과골절。남14례，녀7례；년령19~72세，평균45.2세；평지뉴상9례，추락상7례，차화상5례；균위폐합성골절；균반비골원단골절급관절연골면손상；환자술전균표현위족과부종창、기형급활동수한。근거 Haraguchi CT 분형：Ⅰ형13례，Ⅱ형5례，Ⅲ형3례；종외상도수술시간1~12 d，평균5.1 d；채용내외측연합입로절개복위내고정；술후정기수방절개급골절유합정황，병채용 Baird Jackson 평정표준화 SF_36분별평개술후과관절공능화술후환자생활질량。결과21례환자균획완정수방，시간13~46개월，평균22.3개월。수술시간55~90min，평균（65.7±29.6）min；주원시간5~17d，평균（8.2±1.8）d；술후2 d X 선편현시，해부복위（경골원단관절면무태계）17례，복위량（유1 mm 태계）4례，해부복위솔81.0％；절구균일기유합；골절유합시간11~19주，평균14.6주，무골불련급기형유합。말차수방시 Baird Jackson 평분위91~100분，평균95.5분，기중우14례，량7례，우량솔100％。SF_36생리평분33.2~66.5분，평균（47.6±5.7）분，SF_36심리평분28.9~66.5분，평균（48.4±4.9）분。결론내경형후과골절채용내외측연합입로가이획득량호적수술시야，병가직시하복위고정소유골절괴，사지체도해부복위，종이획득만의림상료효，시치득추천적수술입로。
Objective To evaluate the clinical outcomes of posteromedial combined with posterolateral approach for treat_ment of the medial extension type of posterior malleolar fractures. Methods Data of 117 patients with posterior malleolar frac_tures from March 2009 to March 2013 were retrospectively analyzed. 21 patients whose X_Ray and CT scan showed medial ex_tension type of posterior malleolar fractures were involved in this study. There were 14 males and 7 females with mean age of 45. 2 years old(range,19 ~ 72 years). The mechanisms of injuries includes plain sprained in nine cases,falling injury in seven cases,and motor vehicle accidents in five cases. All the patients combined with distal fibular fracture and with articular carti_lage injuries. Preoperatively,all of patients have foot and ankle swelling,deformity,and restricted movement. The fracture type includes Ⅰ in 13 cases,Ⅱ in 5 cases,and Ⅲ in three cases,according to Haraguchi CT type. The period from injury to surgery was 1 ~ 12 days,with an average of 5. 1 days. The posteromedial combined with posterolateral approach was used to open re_duction and internal fixation for fracture. These data were recorded,including the surgical time,length of hospital stay,fracture healing time,quality of reduction,clinical function which was evaluated according to Baird Jackson criterion,and SF_36. Re_sults All 21 patients had followed up for 13 ~ 46 months(mean,22. 3 months). The mean surgical time and length of hospital stay was(65. 7 ± 29. 6)mins and(8. 2 ± 1. 8)d,respectively. Postoperative 2 days alignment based on plain radiographic im_ages was anatomical reduction in 17(81. 0% )cases with no articular stepoff,and good reduction in 4 cases with 1 mm of stepoff. The incisions were primary healed in all patients. All patients achieved fracture union and healing time was 11 ~ 19 weeks(mean,14. 6 weeks). There were excellent outcomes in 14 patients and good in 7 patients,and 100% patients with good to excellent outcomes. SF_36 scores of physical composite score and mental composite score was(47. 6 ± 5. 7)points and(48. 4 ± 4. 9)points,respectively. Conclusion Treatment of medial extension type of posterior malleolar fractures using the pos_teromedial combined with posterolateral approach,can achieve a good surgical field,and easy to achieve an anatomical reduc_tion which lead to obtain a satisfactory clinical outcomes. Therefore this combined approach has certain superiority.