通讯作者: 邓雄伟, dengxiongwei1130@163.com

DOI：10.12201/bmr.202601.00028

• 摘要：目的：对比后外侧切口与改良跟腱后内侧切口治疗Haraguchi Ⅱ型后踝骨折的临床疗效。方法：回顾性分析2022年6月至2025年6月收治的50例Haraguchi Ⅱ型后踝骨折患者，其中男30例，女20例，平均年龄40.5岁。致伤原因：扭伤32例，车祸伤18例；所有骨折均为闭合性。根据Lauge-Hansen分型：旋后外旋型（supination-external rotation, SER）Ⅲ度17例，SER Ⅳ度21例，旋前外旋型（pronation-external rotation, PER）Ⅳ度12例。将患者分为后外侧切口组（25例）与改良跟腱后内侧切口组（25例），比较两组手术时间、术后并发症（切口愈合情况及神经损伤）、术后影像学评估结果，以及术后6个月美国足踝外科协会足与踝关节评分（American Orthopaedic Foot & Ankle Society, AOFAS）。结果：所有患者均获随访，随访时间10–16个月，平均12个月。改良跟腱后内侧切口组手术时间显著短于后外侧组（P<0.05）。并发症方面：后外侧组切口延迟愈合2例、腓肠神经牵拉伤2例；改良跟腱后内侧切口组切口延迟愈合1例、胫神经牵拉伤1例；所有神经损伤症状均在术后3个月随访时消失。两组并发症发生率差异无统计学意义（P>0.05）。影像学评估显示，以术后CT关节面间隙＞2 mm为复位不良标准，后外侧组复位不良发生率为20%（5/25），改良跟腱后内侧切口组为0，差异有统计学意义（P<0.05）。术后6个月AOFAS评分优良率后外侧组为60%，改良跟腱后内侧切口组为96%，两组差异有统计学意义（P<0.05）。结论：改良跟腱后内侧切口治疗Haraguchi Ⅱ型后踝骨折，可在直视下同时复位后踝与内踝，实现后踝关节面的解剖复位，缩短手术时间，临床疗效优于后外侧切口，是一种较为理想的手术入路。

  关键词： 后外侧; 改良跟腱后内侧; 手术切口; 后踝骨折; 临床疗效

   

  Abstract: Objective To compare the clinical outcomes between the posterolateral approach and the modified posteromedial trans?Achilles approach in the treatment of Haraguchi type II posterior malleolar fractures. Methods A retrospective analysis was conducted on 50 patients with Haraguchi type II posterior malleolar fractures treated between June 2022 and June 2025. There were 30 males and 20 females, with a mean age of 40.5 years. Injury mechanisms included sprain (32 cases) and traffic accidents (18 cases); all fractures were closed. According to the Lauge?Hansen classification, there were 17 cases of supination?external rotation (SER) stage III, 21 cases of SER stage IV, and 12 cases of pronation?external rotation (PER) stage IV. Patients were divided into a posterolateral approach group (25 cases) and a modified posteromedial trans?Achilles approach group (25 cases). Operative time, postoperative complications (wound healing and nerve injury), postoperative imaging findings, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle?hindfoot score at 6 months postoperatively were compared between the two groups. Results All patients were followed up for 10–16 months (mean 12 months). The modified posteromedial group showed significantly shorter operative time than the posterolateral group (P<0.05). Complications included delayed wound healing in 2 cases and sural nerve traction injury in 2 cases in the posterolateral group, and delayed wound healing in 1 case and tibial nerve traction injury in 1 case in the modified posteromedial group. All nerve symptoms resolved by the 3?month follow?up, with no significant difference in overall complication rate between the groups (P>0.05). Imaging evaluation based on postoperative CT revealed a step?off >2 mm in 5 cases (20%) in the posterolateral group, whereas no cases in the modified posteromedial group had poor reduction, showing a statistically significant difference (P<0.05). At 6 months postoperatively, the excellent?good rate of AOFAS score was 60% in the posterolateral group and 96% in the modified posteromedial group, with a statistically significant difference (P<0.05). Conclusion The modified posteromedial trans?Achilles approach allows direct visualization for simultaneous reduction of the posterior and medial malleoli, achieves anatomical reduction of the posterior articular surface, shortens operative time, and yields better clinical outcomes compared with the posterolateral approach, making it a preferable surgical option for Haraguchi type II posterior malleolar fractures.

  Key words: Posterolateral; Modified posteromedial Achilles tendon; Surgical approach; Posterior malleolus fracture; Clinical efficacy

  提交时间：2026-01-11

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• 序号	提交日期	编号	操作
  1	2025-12-30	10.12201/bmr.202601.00028V1	下载

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