目的：探讨经后外侧入路应用锁定接骨板治疗大块后踝骨折的临床疗效。方法：2010年1月-2012年6月经后外侧入路应用锁定接骨板内固定治疗后踝大块骨折患者23例，其中男性15例，女性8例；年龄32～78岁，平均年龄43．7岁；受伤至手术时间5～12d，平均7．3d。术前以石膏或跟骨牵引术固定患肢，待患肢肿胀消退后，采用后外侧入路锁定接骨板治疗后踝骨折。根据美国足踝外科协会（American Orthopedic Foot and Ankle Society ，AOFAS ）的踝与后足评分标准评价踝关节功能。结果：所有患者均获得随访，随访时间14～22个月，平均17．4个月。23例患者均获得骨性愈合，无内固定松动或断裂；X线片示骨折愈合时间为术后11～21周，平均14．7周；完全负重时间为15～25周，平均17．1周；术后12个月AOFAS评分为73～94分，平均83．4分。1例患者术后第7天出现伤口浅表感染，经换药及敏感抗生素治疗后愈合，其他患者伤口愈合良好。结论：采用后外侧入路锁定接骨板治疗能在直视下对后踝进行有效复位和妥当固定，用于治疗后踝大块骨折时疗效良好。%Objective:To investigate the clinical efficacy of posterolateral locking plate in the treatment of large posterior malle-olar fracture .Methods :From January 2010 to June 2012 ,23 patients with large posterior malleolar fractures were treated by posterolateral locking plate ,including 15 males and 8 females ,all of whom aged from 32 to 78 years with an average age of 43 .7 years .The average time from injury to operation was 7 .3 days ,which ranged from 5 to 12 days .Calcaneal traction fixa-tion or plaster was performed on the injured limb before operation .Once that swelling reduced ,all patients were treated by posterolateral locking plate and were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS) .Results:The follow-up time was from 14 to 22 months ,with an average period of 17 .4 months . 23 patients resulted in bone healing ,without loosen or breakage of internal fixation .As the X-ray pictures showed ,fracture healing time after operation ranged from 11 to 21 weeks ,which was 14 .7 weeks on average ,and full weight bearing time was from 15 to 25 weeks ,which was 17 .1 weeks on average .The AOFAS scores ranged from 73 to 94 points with an average of 83 .4 points at the 12th month after operation .One patient had superficial wound infection at the 7th day after operation and was healed by sensitive antibiotics and changing fresh dressing .Conclusions :Posterolateral locking plate could be a good method for the treatment of posterior malleolar fracture because effective redution and proper fixation could be obtained through straight access .
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