【摘要】 目的：比较经腓骨后外侧入路、经腓骨入路内固定术治疗旋后外旋型Ⅳ度踝关节骨折（AF）的疗效。方法：2019年1月至2021年3月收治的旋后外旋型Ⅳ度AF患者126例，2019年1月至2019年10月采用经腓骨入路内固定术治疗的50例为腓骨入路组，2019年11月至2021年3月采用经腓骨后外侧入路内固定术治疗的76例为腓骨后外侧入路组，比较两组手术疗效、术后康复情况，术后6个月的踝关节功能、骨折愈合情况、并发症发生率等。结果：腓骨后外侧入路组术中出血量低于腓骨入路组的，切口长度、手术时间、住院时间、骨折愈合时间短于腓骨入路组（P<0.05）。术后6个月，两组AOFAS踝与后足功能评分均高于术前，且腓骨后外侧入路组高于腓骨入路组（P<0.05）。腓骨后外侧入路组踝关节伸、屈、旋前、旋后活动度高于腓骨入路组（P<0.05）。术后6个月，腓骨后外侧入路组骨折愈合、关节功能优良率均高于腓骨入路组（93.4%vs. 86.0%,P=0.025;88.2%vs. 76.0%,P=0.034），腓骨后外侧入路组总并发症发生率低于腓骨入路组（3.9%vs. 22.0%,P=0.004）。结论：经腓骨后外侧入路内固定术治疗旋后外旋型Ⅳ度踝关节骨折，可改善患者围手术期指标，促进骨折愈合，提高踝关节活动度及踝关节功能，降低并发症发生风险，值得临床推广。更多还原

【Abstract】 Objective: To compare the efficacy of transfibular posterolateral approach and transfibular approach in the treatment of supination and external rotation type Ⅳankle fractures(AF). Methods: From January 2019 to March 2021, 126 patients with supination and external rotation type Ⅳ AF were collected and divided into fibular approach group with 50 patients treated by internal fixation via the fibular approach from January 2019 to October 2019 and posterolateral fibular approach group with 76 patients treated by internal fixation via the transfibular posterolateral approach from November 2019 to March 2021. The surgical efficacy and postoperative rehabilitation of the two groups were compared. Six months after the operation, the ankle joint function, fracture healing and complication rates of the two groups were compared. Results: The intraoperative blood loss in posterolateral fibular approach group was lower than that in fibular approach group(P<0.05), and the length of incision, operation time, hospital stay, and fracture healing time were shorter than those in fibular approach group(P<0.05). At 6 months after operation, the AOFAS ankle and hindfoot function scores of the two groups were higher than those before operation, and posterolateral fibular approach group was higher than fibular approach group(P<0.05); the range of motion of ankle joint extension, flexion, pronation and supination in the posterolateral fibular approach group were higher than that in the fibular approach group(P<0.05). The fracture healing and excellent and good rates of joint function in posterolateral fibular approach group were higher than those in fibular approach group at 6 months after the operation(93.4% vs. 86.0%, P=0.025; 88.2% vs. 76.0%, P=0.034), and the total complication rate was lower in posterolateral fibular approach group than in fibular approach group(3.9% vs. 22.0%, P=0.004). Conclusions: Transfibular posterolateral approach in the treatment of patients with supination and external rotation type Ⅳ AF has advantages of improving perioperative indicators, fracture healing and ankle function, and reducing the incidence of complications, which is worthy of clinical promotion.更多还原