【摘要】 目的 比较三踝骨折手术时后踝骨折前向后与后向前螺钉固定的疗效。方法 回顾性分析2011年1月～2022年10月因后踝骨折行拉力螺钉固定治疗并随访12个月以上共376例资料。按骨折块厚度分为2个亚组，小骨折亚组为骨折块厚度<17 mm(螺钉螺纹长度)共167例，大骨折亚组为骨折块厚度≥17 mm共209例。每个亚组根据后踝骨折螺钉内固定方向不同分为前向后组与后向前组，小骨折亚组前向后74例，后向前93例；大骨折亚组前向后88例，后向前121例。对比末次随访美国足踝矫形外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足评分，测量术后第1天以及末次随访X线片骨折块在骨折线方向上的位移(Dn)和垂直于骨折线方向上的位移(Dt),计算术后骨折块移位，即末次随访Dn+Dt与术后第1天Dn+Dt之差。结果 术后第1天X线显示，小骨折和大骨折亚组前向后组对比后向前组Dn和Dt差异均无显著性(P>0.05)。全组随访12～85个月，平均19.3月。在小骨折亚组，术后骨折块移位后向前组[(0.11±0.19)mm]优于前向后组[(0.19±0.21)mm](P=0.011),AOFAS评分也优于前向后组[(80.2±8.4)分vs.(76.2±8.6)分，P=0.003];在大骨折亚组，术后骨折块移位后向前组[(0.11±0.18)mm]与前向后组[(0.12±0.19)mm]无统计学差异(P=0.630),AOFAS评分也无统计学差异[(84.1±7.8)分vs.(82.8±7.6)分，P=0.246]。结论 后踝骨折前向后与后向前拉力螺钉内固定在复位效果上无明显区别。对于骨折块厚度<17 mm者，后向前固定疗效优于前向后固定；对于骨折块厚度≥17 mm者，前向后固定与后向前固定在疗效上无明显区别。更多还原

【Abstract】 Objective To compare the efficacy of anterior-posterior and posterior-anterior screw fixation for posterior malleolar fractures surgery. Methods A retrospective analysis of 376 cases of posterior malleolar fractures treated with lag screws from January 2011 to October 2022 with more than 12 months of follow-up period was conducted. The patients were divided into two subgroups based on the thickness of the fracture fragment, with 167 cases in the small fracture subgroup having a fracture fragment thickness <17 mm(screw thread length) and 209 cases in the large fracture subgroup having a fracture fragment thickness ≥17 mm. Each subgroup was further divided into anterior-posterior and posterior-anterior groups based on the direction of screw fixation in the posterior malleolar fracture surgery. In the small fracture subgroups, there were 74 cases in the anterior-posterior group and 93 cases in the posterior-anterior group. In the large fracture subgroup, there were 88 cases in the anterior-posterior group and 121 cases in the posterior-anterior group. The American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score was measured at the last follow-up. The displacement of the fracture fragment in the direction of the fracture line(Dn) and perpendicular to the fracture line(Dt) were measured on the first day after surgery and at the last follow-up, and the displacement of the fracture fragment was calculated, which was the difference between Dn+Dt at the last follow-up and Dn+Dt on the first day after surgery. Results On the first day after surgery, X-ray showed no significant difference in Dn and Dt between the anterior-posterior and posterior-anterior groups in both of the small and large fracture subgroups(P>0.05). The entire group was followed up for 12-85 months, with an average of 19.3 months. In the small fracture subgroup, the displacement of the fracture fragment in the posterior-anterior group [(0.11±0.19) mm] was superior to that in the anterior-posterior group [(0.19±0.21) mm; P=0.011], and the AOFAS score was also superior to that in the anterior-posterior group [(80.2±8.4) points vs.(76.2±8.6) points, P=0.003]. In the large fracture subgroup, there was no significant difference in fracture displacement between the posterior-anterior group [(0.11±0.18) mm] and the anterior-posterior group [(0.12±0.19) mm; P=0.630], and there was also no significant difference in AOFAS scores [(84.1±7.8) points vs.(82.8±7.6) points, P=0.246]. Conclusions There is no significant difference in the reduction effect between anterior-posterior and posterior-anterior lag screw internal fixation for posterior malleolar fractures in trimalleolar fractures. For patients with fracture thickness <17 mm, posterior-anterior fixation is superior to anterior-posterior fixation; for patients with fracture thickness ≥17 mm, there is no significant difference in the efficacy between anterior-posterior and posterior-anterior fixation.更多还原