Abstract：
BACKGROUND: The present study aimed to analyze and compare the efficacy of the anterolateral and posterolateral approaches for surgical treatment of supination-external rotation type IV ankle fractures.
METHODS: This retrospective study enrolled 60 patients (60 feet) with supination-external rotation type IV ankle fractures, including 30 patients (30 feet) treated by means of the anterolateral approach and 30 patients (30 feet) treated by means of the posterolateral approach. Postoperative clinical efficacy was compared between the groups based on operation time, intraoperative blood loss, postoperative complications, fracture healing time, visual analog scale scores, Short Form-36 Health Survey scores, and American Orthopedic Foot and Ankle Society scores. Comparisons between the two groups were performed using independent-samples t tests and analyses of variance. Intragroup differences were compared using paired t tests, and the χ2 test was used to compare categorical variables.
RESULTS: All 60 included patients completed follow-up ranging from 12 to 18 months (mean duration, 14.8 ± 3.5 months). Although baseline characteristics were similar in the two groups, there were significant differences in operation time (86.73 ± 17.44 min versus 111.23 ± 10.05 min; P < .001) and intraoperative blood loss (112.60 ± 25.05 mL versus 149.47 ± 44.30 mL; P < .001). Although fracture healing time (10.90 ± 0.66 weeks versus 11.27 ± 0.94 weeks; P = .087) was shorter in the anterolateral group than in the posterolateral group, the difference was not significant. Postoperative complications occurred in one and three patients in the anterolateral and posterolateral approach groups, respectively. Visual analog scale scores were significantly lower in the anterolateral group than in the posterolateral group (1.43 ± 0.50 versus 1.83 ± 0.75; P = .019), although there was no significant difference in Short Form-36 Health Survey scores between the groups (73.63 ± 4.07 versus 72.70 ± 4.04; P = .377). However, American Orthopedic Foot and Ankle Society scores were higher in the anterolateral group than in the posterolateral group (80.43 ± 4.32 versus 75.43 ± 11.32; P = .030).
CONCLUSIONS: Both the anterolateral and posterolateral approaches can achieve good results in the treatment of supination-external rotation type IV ankle fractures. Compared with the posterolateral approach, the anterolateral approach is advantageous for the treatment of supination-external rotation type IV ankle fractures given its safety and ability to reduce trauma, clear field of view revealed, and allow for exploration and repair of the inferior tibiofibular anterior syndesmosis within the same incision.
METHODS: This retrospective study enrolled 60 patients (60 feet) with supination-external rotation type IV ankle fractures, including 30 patients (30 feet) treated by means of the anterolateral approach and 30 patients (30 feet) treated by means of the posterolateral approach. Postoperative clinical efficacy was compared between the groups based on operation time, intraoperative blood loss, postoperative complications, fracture healing time, visual analog scale scores, Short Form-36 Health Survey scores, and American Orthopedic Foot and Ankle Society scores. Comparisons between the two groups were performed using independent-samples t tests and analyses of variance. Intragroup differences were compared using paired t tests, and the χ2 test was used to compare categorical variables.
RESULTS: All 60 included patients completed follow-up ranging from 12 to 18 months (mean duration, 14.8 ± 3.5 months). Although baseline characteristics were similar in the two groups, there were significant differences in operation time (86.73 ± 17.44 min versus 111.23 ± 10.05 min; P < .001) and intraoperative blood loss (112.60 ± 25.05 mL versus 149.47 ± 44.30 mL; P < .001). Although fracture healing time (10.90 ± 0.66 weeks versus 11.27 ± 0.94 weeks; P = .087) was shorter in the anterolateral group than in the posterolateral group, the difference was not significant. Postoperative complications occurred in one and three patients in the anterolateral and posterolateral approach groups, respectively. Visual analog scale scores were significantly lower in the anterolateral group than in the posterolateral group (1.43 ± 0.50 versus 1.83 ± 0.75; P = .019), although there was no significant difference in Short Form-36 Health Survey scores between the groups (73.63 ± 4.07 versus 72.70 ± 4.04; P = .377). However, American Orthopedic Foot and Ankle Society scores were higher in the anterolateral group than in the posterolateral group (80.43 ± 4.32 versus 75.43 ± 11.32; P = .030).
CONCLUSIONS: Both the anterolateral and posterolateral approaches can achieve good results in the treatment of supination-external rotation type IV ankle fractures. Compared with the posterolateral approach, the anterolateral approach is advantageous for the treatment of supination-external rotation type IV ankle fractures given its safety and ability to reduce trauma, clear field of view revealed, and allow for exploration and repair of the inferior tibiofibular anterior syndesmosis within the same incision.
摘要：
背景：本研究旨在分析和比较前外侧和后外侧入路手术治疗旋后-外旋IV型踝关节骨折的疗效。
方法：这项回顾性研究纳入了60例（60英尺）旋后外旋IV型踝关节骨折患者，包括通过前外侧入路治疗的30例患者（30英尺）和通过后外侧入路治疗的30例患者（30英尺）。根据手术时间比较两组患者术后临床疗效,术中失血,术后并发症,骨折愈合时间,视觉模拟量表评分，简短表格-36健康调查分数，和美国骨科足踝协会的得分。两组之间的比较使用独立样本t检验和方差分析进行。使用配对t检验比较组内差异，并采用χ2检验比较分类变量。
结果：所有60例患者均完成了12至18个月的随访（平均持续时间，14.8±3.5个月)。尽管两组的基线特征相似，手术时间（86.73±17.44min与111.23±10.05min;P<.001）和术中出血量（112.60±25.05mL与149.47±44.30mL;P<.001）差异有统计学意义。尽管前外侧组的骨折愈合时间（10.90±0.66周与11.27±0.94周；P=0.087）短于后外侧组，差异不显著。前外侧和后外侧入路组中有1例和3例患者发生术后并发症，分别。前外侧组视觉模拟量表评分明显低于后外侧组(1.43±0.50vs1.83±0.75;P=0.019),尽管两组之间的ShortForm-36健康调查评分没有显着差异（73.63±4.07和72.70±4.04；P=.377）。然而,前外侧组的美国骨科足踝协会评分高于后外侧组（80.43±4.32vs.75.43±11.32；P=.030）。
结论：前外侧入路和后外侧入路治疗旋后-外旋型Ⅳ型踝关节骨折均能取得良好的疗效。与后外侧入路相比,前外侧入路治疗旋后外旋IV型踝关节骨折具有较好的安全性和减少创伤的能力,清晰的视野显示，并允许在同一切口内探查和修复下胫腓前结合。
方法：这项回顾性研究纳入了60例（60英尺）旋后外旋IV型踝关节骨折患者，包括通过前外侧入路治疗的30例患者（30英尺）和通过后外侧入路治疗的30例患者（30英尺）。根据手术时间比较两组患者术后临床疗效,术中失血,术后并发症,骨折愈合时间,视觉模拟量表评分，简短表格-36健康调查分数，和美国骨科足踝协会的得分。两组之间的比较使用独立样本t检验和方差分析进行。使用配对t检验比较组内差异，并采用χ2检验比较分类变量。
结果：所有60例患者均完成了12至18个月的随访（平均持续时间，14.8±3.5个月)。尽管两组的基线特征相似，手术时间（86.73±17.44min与111.23±10.05min;P<.001）和术中出血量（112.60±25.05mL与149.47±44.30mL;P<.001）差异有统计学意义。尽管前外侧组的骨折愈合时间（10.90±0.66周与11.27±0.94周；P=0.087）短于后外侧组，差异不显著。前外侧和后外侧入路组中有1例和3例患者发生术后并发症，分别。前外侧组视觉模拟量表评分明显低于后外侧组(1.43±0.50vs1.83±0.75;P=0.019),尽管两组之间的ShortForm-36健康调查评分没有显着差异（73.63±4.07和72.70±4.04；P=.377）。然而,前外侧组的美国骨科足踝协会评分高于后外侧组（80.43±4.32vs.75.43±11.32；P=.030）。
结论：前外侧入路和后外侧入路治疗旋后-外旋型Ⅳ型踝关节骨折均能取得良好的疗效。与后外侧入路相比,前外侧入路治疗旋后外旋IV型踝关节骨折具有较好的安全性和减少创伤的能力,清晰的视野显示，并允许在同一切口内探查和修复下胫腓前结合。
