目的 比较外侧中和钢板及后外侧抗滑钢板内固定治疗Danis-Weber/AO B型闭合性外踝骨折的疗效。方法 选择2012-03至2015-06医院收治的Danis-Weber/AO B型闭合性外踝骨折44例,根据患者意愿分为外侧中和钢板固定组(中和组,24例),后外侧抗滑钢板固定组(抗滑组,20例)。中和组骨折解剖复位,选取合适的拉力螺钉自前向后垂直于骨折线置入,腓骨外侧解剖钢板固定于腓骨外侧合适的位置;抗滑组骨折解剖复位,钢板放置于腓骨后外侧,使用合适的螺钉内固定,最少随访1年。术后1年根据美国足踝外科协会后足踝评分系统(AOFAS)进行功能评价,记录并发症。结果 术后1年中和组和抗滑组AOFAS评分分别为93.7±6.1和94.5±6.0,两组比较没有统计学差异(P=0.37)。中和组7例(29.3%)发生并发症,抗滑组3例(15.0%)发生并发症,其中1例腓骨肌腱病,两组并发症发生率比较,差异无统计学意义(P=0.31)。结论 对旋后外旋型损伤的Danis-Weber/AO B型外踝骨折进行手术治疗,与传统的外侧钢板固定技术比较,抗滑组手术效果与之相当,并发症发生率无差异,两种技术均安全有效,值得推广。

Objective To compare the efficacy of internal fixation with the lateral neutral plate and posterolateral anti-slip plate respectively in the treatment of Danis-Weber/AO type B closed lateral malleolus fractures.Methods Forty-four patients with Danis-Weber/AO type B closed lateral malleolus fractures admitted to hospital between March 2012 and June 2015 were selected and divided into the lateral neutral plate fixation group (neutral group, n=24) and the posterolateral anti-slip plate fixation group (anti-slip group, n=20) according to their willingness. In the neutral group, fractures were anatomically reduced, and appropriate lag screws were placed from the front to the back perpendicularly to the fracture line. The anatomic plate of the lateral fibula was fixed in an appropriate position on the lateral fibula. Anatomic reduction was performed in the anti-slip group. The plates were placed on the posterolateral side of the fibula, and internal fixation was performed with appropriate screws. The minimum follow-up was one year. One year after operation, functional evaluation was conducted according to the American Association of Foot and Ankle Surgeons posterior foot and ankle scoring system (AOFAS), and complications were recorded.Results AOFAS scores of the two groups were 93.7±6.1(neutral group ) and 94.5±6.0 (anti-slip group) respectively one year after operation. There was no statistically significant difference between the two groups (P=0.37).Complications occurred in seven cases (29.3%) in the neutral group, and in three cases (15.0%) in the anti-slip group, including one case of peroneal tendon disease. There was no statistically significant difference in the incidence of complications between the two groups (P=0.31).Conclusion During surgical treatment of Danis-Weber /AO type B lateral malleolus fractures with supination-external rotation type injury, the therapeutic effect of the traditional lateral plate fixation technique and the anti-slip plates is comparable, and the incidence of complications is low. Both approaches are safe and effective.