背景:该研究的目的是从局部并发症方面评估改良后内侧入路(MfPM)在复杂踝关节骨折手术治疗中的安全性。
方法:回顾性多中心回顾了2016年至2022年间通过后踝关节入路手术治疗的一系列踝关节骨折。使用了两种方法。在MfPM组中,患者被放置在俯卧位,切口在跟腱内侧1cm处。在后外侧入路(PL)组中,患者被置于俯卧或侧卧位置,并在外踝和跟腱之间切开切口。并发症评估分为伤口并发症,感染,神经炎,血管改变和其他。
结果:经切开复位内固定治疗的81例踝关节骨折伴后踝碎片。通过MfPM方法接近20例,通过PL访问61例。平均随访18.60个月(4-78个月)。MfPM组局部并发症发生率为10%(2/10例),两者都对应于不需要手术干预的轻微伤口问题。未发现感染或其他神经或血管并发症。在PL组中,发现并发症发生率为8,19%(5/61例患者),所有这些都对应于不需要手术干预的轻微伤口问题。未发现感染或其他神经或血管并发症。两种方法在术后局部并发症方面没有显着差异(z评分0.249-P:0.803)。
结论:MfPM方法是安全的,并且由于术后局部并发症的发生率低,可以像PL一样容易使用。尤其是在具有大碎片和后内侧延伸的骨折中,在这种骨折中,更多的进入后pilon可以促进解剖复位和固定的器械。
BACKGROUND: The aim of the study was to evaluate the safety of the modified posteromedial approach (MfPM) in the surgical management of complex ankle fractures in terms of local complications.
METHODS: Retrospective multicenter review of a series of malleolar fractures surgically treated by posterior ankle approaches between 2016 and 2022. Two approaches were used. In the MfPM group patients were placed in a prone position and the incision was made 1 cm medially to the Achilles tendon. In the posterolateral access (PL) group patients were placed in a prone or lateral decubitus position and the incision was made between the lateral malleolus and the Achilles tendon. Complications evaluated were divided into wound complications, infections, neuritis, vascular alterations and others.
RESULTS: 81 ankle fractures with a posterior malleolar fragment treated by open reduction and internal fixation were identified. 20 cases were approached through the MfPM approach and 61 through the PL access. The mean follow up was 18.60 months (range 4-78 months). In the MfPM group the local complication rate was 10% (2/10 patients), both corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. In the PL group a complication rate of 8,19% (5/61 patients) was found, all of them corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. There were no significant differences between the two approaches regarding postoperative local complications (z score 0.249 - P: 0.803).
CONCLUSIONS: The MfPM approach is safe and may become as readily used as the PL due to the low incidence of postoperative local complications, especially in fractures with a large fragment and posteromedial extension in which greater access to the posterior pilon can facilitate instrumentation for anatomic reduction and fixation.