目的 探讨切开复位内固定结合跟骨前突置钉外固定架技术治疗伴明显踝关节不稳三踝骨折的临床效果.方法 回顾分析2012年1月～2015年12月沧州市中心医院骨科因明显踝关节不稳三踝骨折接受切开复位内固定结合跟骨前突置钉外固定架技术治疗的23例患者临床资料.所有患者均为闭合性骨折,均合并不同程度的距骨后脱位,后踝骨折块占关节面≥25％.根据Lauge-Hansen分型,旋前外旋Ⅳ度9例,旋后外旋Ⅳ度14例.手术4周之后每周1次放松外架,锻炼踝关节屈伸活动.通过分析围术期数据及随访资料,评价患者术后的临床效果.结果 本组手术时间为(59.5±21.4)min,术中出血量为(101.5±33.7)mL,住院时间为(11.5±3.3)d.术后1例(4.3％)发生腓骨切口周围浅表炎性反应,经处理后愈合良好.所有病例未发生神经、血管损伤并发症情况.围术期总体并发症发生率为4.3％.所有患者均获得随访,平均(15.8±4.3)个月随访.所有病例骨折均愈合,未见复位丢失情况.Lowa踝关节评分及VAS评分在术后各随访时间点之间比较,差异无统计学意义(P＞0.05).在末次随访时,Lowa踝关节评分及VAS评分分别为(86.9±5.4)、(2.7±0.6)分;根据Maryland评分,总体优良率为91.3％.结论 切开复位内固定结合跟骨前突置钉外固定架技术治疗伴明显踝关节不稳的三踝骨折临床效果良好,固定可靠,是一种可供选择的手术治疗方法.%Objective To investigate clinical effect of the external fixator pinning in anterior process of calcaneus combined with open reduction and internal fixation in treatment of instable trimalleolar fracture of the ankle.Methods From January 2012 to December 2015,in Central Hospital of Cangzhou City,the clinical data of 23 patients with instable trimalleolar fracture of the ankle treated by the external fixator pinning in anterior process of calcaneus combined with open reduction and internal fixation were retrospectively analyzed.All cases were closed fractures with posterior subluxation of the talus.All patients had posterior malleolar fragments involving the tibial articular surface ≥ 25％.According to Lauge-Hansen classification,9 cases were with pronation external rotation type Ⅳ,14 cases with supination and external rotation type Ⅳ.External fixator was relaxed for once per week after operation 4 weeks in order to exercise motion of ankle.At postoperative fellow-up,outcomes were measured by clinical scores and serial radiographic analysis.Results The operation time was (59.5±21.4) min,intraoperative blood loss was (101.5±33.7) mL,and length of stay was (115±3.3) d.Regarding complications,one cases (4.3％) had postoperative superficial inflammatory reaction around fibular incision,they healed well afer surgery treatment.There was no occurrence of injury fo blood vessels or nerves.The incidence of perioperative complications was 4.3％.All patients were followed up for mean (15.8±4.3) months.All fractures were healed without loss of reduction.For Lowa ankle score and VAS score,there was not significant different during postoperative follow-up points (P ＞0.05).At the last follow-up,Lowa ankle score and VAS score were (86.9±5.4),(2.7±0.6) scores.According to the Maryland score,the good rate of the curative effect was 91.3％.Conclusion Clinical results of the external fixator pinning in anterior process of calcaneus combines with open reduction and internal fixation in treatment of instable trimalleolar fracture of the ankleare is good.The complication rate is low.This is an alternative method in the treatment ofinstable trimalleolar fracture of the ankle.
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