Clinical Study On The Treatment Of Posterior Malleolus Fractures By The Modified Approach Near The Achilles Tendon With Integrated Traditional Chinese And Western Medicine

Objective: To explore the feasibility,efficacy and advantages of Zheng’s bone setting manipulation combined with modified approach near Achilles tendon in the treatment of posterior malleolus fracture,as well as the development prospect of clinical application.Methods: from January 2017 to October 2019,a retrospective study was conducted on 146 cases of ankle fractures treated by surgery in the foot and ankle Department of Sichuan orthopedic hospital.According to the improved routine examination,preoperative and postoperative X-ray,CT and other imaging examinations and follow-up data,146 cases were collected;According to the operation method,they were divided into two groups: the modified group(94 cases of Zheng’s bone setting manipulation combined with modified approach near Achilles tendon)and the control group(52 cases of Zheng’s bone setting manipulation combined with medial incision reduction and percutaneous screw fixation from anterior to posterior);The clinical examination and reexamination films were collected after operation.The fracture reduction was recorded according to Burwell Charnley [63] radiological evaluation standard.The ankle function was evaluated by American Orthopaedic Foot & Ankle Society(AOFAS)ankle hindfoot index 12 months after operation.Results: 146 cases were followed up completely,94 cases in the improved group were followed up from September to 21 months,the average time was 13.5 months ± 1.2 months;The control group(52 cases)was followed up from August to 18 months,with an average time of 14.5 months ± June.At the last follow-up,all patients achieved clinical healing,and no fracture reduction loss,internal fixation fracture or failure occurred in all patients.One case of superficial peroneal nerve injury occurred in the control group;In the modified group,no important nerves and blood vessels were injured during and after operation,and all incisions were healed in the first stage(about 12-14 days after operation).No infection or skin necrosis occurred in all follow-up cases.According to Burwell Charnley [63] radiological evaluation criteria,posterior malleolus reduction: improved group: anatomical reduction in 86 cases(91.5%);In the control group,34 cases(65.4%)underwent anatomical reduction.The two groups were passed through as a whole 2 Test,(P = 0.001 < 0.05),there was a high degree of statistical difference,in which bartonicek: type Ⅱ had statistical difference between the two groups(P = 0.004 < 0.05),bartonicek: type ⅡI,type IV had no statistical difference between the two groups(P = 0.061 > 0.05,P = 0.127 > 0.05).AOFAS ankle and hindfoot score: improved group: the overall score was 90-98,the average was 93.49 ± 28 points,of which 94 cases(100%)were excellent.Control group: the overall score was 87-95,with an average of 90.44 ± 79 points,including excellent in 45 cases(86.5%),good in 7 cases(13.5%).There was no statistical difference between the two groups(P = 0.086 > 0.05).There was statistical difference between bartonicek: type Ⅱ and bartonicek: type ⅡI and type IV(P = 0.071 > 0.05,P = 0.078 > 0.05).Conclusion: compared with Zheng’s bone setting manipulation combined with medial incision reduction and percutaneous screw fixation(AP)of posterior malleolus,Zheng’s bone setting manipulation combined with modified approach beside Achilles tendon can effectively reduce bartonicek Ⅱ,Ⅲ and Ⅳ of posterior malleolus,especially bartonicek Ⅱ.Zheng’s bone setting manipulation combined with modified approach near Achilles tendon has good results,which is a good approach for the treatment of posterior malleolus,especially for bartonicek type Ⅱ.