Therapeutic effects of reconstruction of ankle joint via posterior approach on malunion ankle fracture involving posterior malleolar and fibular fracture

doi:10.3969/j.issn.1009-976X.2022.04.014

Abstract

Abstract: Objective To summarize the clinical outcomes of reconstruction of malunited ankle fracture involving posterior malleolar and fibular fracture via combined posterior approach. Methods From December 2015 to December 2021, 18 malunited ankle fractures involving posterior malleolar and fibular fracture were treated via posterior approach in our departments.All deformities were open and reduced and dislocated ankle were reconstructed; Radiographic assessments were performed using plain radiographs and computed tomographic （CT） scans pre- and post-operation to evaluate the relocation of the fracture, congruence of the ankle joint and the union rate of the bone. The complications were recorded. Clinical outcomes were assessed using the AOFAS ankle-hindfoot score, visual analog scale （VAS）, active range of motion of ankle. Results Eleven patients were followed up with an average period of 32 months （14~48 months）. Postoperatively, congruence of joint and alignment of lower extremity were achieved in all patients as judged by X ray and CT scans. The median AOFAS score improved from 40 to 84（P<0.001）. Median pain VAS score improved from 5.3 to 1.5 （P<0.001）. The ROM of ankle improved from 15 to 35 degree. Conclusion In treatment of malunited ankle fracture involving posterior malleolar and fibular fracture, reduction of the fracture through the combined posterior approach, will reconstruct the congruity of ankle mortise and save the ankle function greatly.

Key words: ankle, Fractures, malunited, posterior malleolar, posterior approach

摘要： 目的治疗陈旧性后踝合并腓骨骨折畸形愈合时,总结联合后路行切开复位、重建踝关节的临床疗效。方法回顾性分析2015年12月至2021年12月,共收治的18例陈旧性后踝骨折合并腓骨骨折畸形愈合的患者,均经联合后内+后外入路行后踝、腓骨骨折畸形愈合切开复位、并重建踝关节解剖对位;其中男11例,女7例;平均年龄41岁（19~61岁）;初次受伤至最终切开复位术平均间隔10个月（8~30个月）,术前后常规行X线及CT检查以评估骨折复位、踝关节解剖对位及骨折愈合情况,记录并发症发生情况,并应用美国骨科足踝外科协会（AOFAS）踝关节与后足功能评分、VAS疼痛评分及踝关节活动度来评估临床疗效。结果共11例患者获随访,平均随访32个月（14~48个月）。术后经X光、CT评估,所有患者踝关节解剖对位较术前均有较明显的改善,且力线恢复良好;AOFAS踝关节与后足功能评分从术前平均40分提高到术后平均84分;VAS评分从术前平均5.3分改善到术后1.5分;踝关节活动度从术前平均15°提高到术后平均35°。结论对于陈旧性后踝合并腓骨骨折畸形愈合患者,联合后路切开解剖复位后踝及腓骨骨折,重建踝关节解剖对位,可较好地复位踝关节解剖结构,并取得较好的疗效。

关键词: 踝关节, 骨折, 畸形愈合, 后踝, 后方入路

CLC Number:

R683.42

LI Wen-gui, CHEN Chen, ZENG Gang, LIU Wen-zhou, CHEN Yan-bo, YANG Tao, SONG Wei-dong. Therapeutic effects of reconstruction of ankle joint via posterior approach on malunion ankle fracture involving posterior malleolar and fibular fracture[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 389-394.

李文贵, 陈宸, 曾钢, 刘文宙, 陈彦博, 杨涛, 宋卫东. 后路行陈旧性后踝合并腓骨骨折畸形愈合重建的疗效[J]. 岭南现代临床外科, 2022, 22(04): 389-394.

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