Effect of Modified Posterolateral Approach Combined with Inside Approach for Open Reduction and Internal Fixation in the Treatment of Senium Trimalleolar Fractures
Objective:To investigate the effect of modified posterolateral approach combined with inside approach for open reduction and internal fixation in the treatment of senium trimalleolar fractures.Method:A total of 80 elderly patients with trimalleolar fracture treated in the Second Hospital of Longyan from April 2018 to December 2022 were selected.They were divided into traditional group(n=40)and modified group(n=40)according to random number table method.The modified group was given the modified posterolateral approach combined with the inside approach for open reduction and internal fixation,and the traditional group was given the traditional posterolateral approach combined with the inside approach for open reduction and internal fixation.Perioperative indexes,pain degree 1 d,3 d and 1 week after surgery,ankle joint motion and ankle joint function before surgery and 6 months after surgery,inflammatory factors before surgery and the first day after surgery and complications were compared between the two groups.Result:The amount of intraoperative blood loss in the modified group was less than that in the traditional group,and the difference was statistically significant(P<0.05).The visual analogue scale(VAS)score of the modified group was lower than that of the traditional group 1 week after surgery,and the difference was statistically significant(P<0.05).Six months after surgery,ankle plantar flexion,dorsal-extension motion and American Association of Foot and Ankle Surgery(AOFAS)score were increased in both groups,and the dorsal-extension motion of ankle joint in the modified group was higher than that in the traditional group,the differences were statistically significant(P<0.05).On the first day after surgery,C-reactive protein(CRP)and procalcitonin(PCT)levels were increased in both groups,and the CRP and PCT levels in the modified group were slightly lower than those in the traditional group,but there was no statistical significance between the two groups(P>0.05).The incidences of sensory paralysis of affected limb and infection in the modified group was lower than that in the traditional group,and the difference was statistically significant(P<0.05).Conclusion:In the surgical treatment of elderly patients with trimalleolar fractures,the modified posterolateral approach combined with the inside approach has the same surgical effect as the traditional lateral approach combined with the inside approach in open reduction and internal fixation,and does not affect the levels of postoperative inflammation-related factors levels in patients after surgery.However,the modified patients have less pain and faster ankle function recovery.Postoperative complications were also relatively rare.
Modified posterolateral approachInside approachOpen reduction and internal fixationTrimalleolar fractureAnkle joint function
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