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目的：探讨采用直接入路治疗三踝骨折的临床疗效。方法2000年1月~2012年1月采用直接入路内固定治疗的47例三踝骨折患者。根据骨折方式和软组织损伤情况制定直接入路手术方案。术后采用Burwell-Charn_ley标准评估骨折复位情况，采用AOFAS踝后足评分和VAS评分进行临床评估。结果本组47例患者平均随访时间24.2月(10~45月)，骨折愈合时间平均13.6周(10~26周)。按Burwell-Charnley标准，本组优23例，良16例，中6例，差2例，优良率82.98%(39/47)。平均AOFAS评分86.5分(71~97分)；平均VAS评分1.4分(0~6分)。4例发生浅表感染，局部换药后治愈；2例开放性骨折出现深部感染，去除内固定改为外固定支架固定后治愈；3例患者出现轻度的畸形愈合；4例延迟愈合；10例患者X线有不同程度的关节退变，其中2例因关节炎程度较重伴有长期疼痛进行了关节融合，其余患者X线虽有关节炎表现但踝关节功能良好。结论直接入路治疗三踝骨折的临床疗效令人满意。“,”Objective To explore the clinical outcomes of treatment of trimalleolar fractures through direct approache. Methods 47 patients with trimalleolar fractures from January 2000 and January 2012 were treated by internal fixation through specific direct approaches. A detailed surgical plan of specific approaches was made by considering the specific fracture patterns and soft tissue injury condition. The Burwell-Charnley scale was used to evaluate the quality of fracture reduction and the American Orthopaedic Foot and Ankle So_ciety ( AOFAS) ankle-hindfoot score and the Visual Analogue Scale ( VAS) were used to evaluate the func_tional outcomes. Results The mean follow-up time of all 47 patients was 24. 2 months ( range: 10 to 45 months). All fractures healed at an average of 13. 6 weeks (range:10 to 26 weeks). The outcomes were excellent in 23 cases, good in 16, fair in 6, and poor in 2, and the excellent-good rate was 82. 98%(39/47) according to the Burwell-Charnley criteria. The mean of AOFAS score was 86. 5 points ( range:71 to 97 points), and the mean of VAS score was 1. 4 points (range:0 to 6 points). Superficial wound infection occurred in 4 patients, which healed with local treatments. Deep tissue infection was found in 2 patients with open fracture, which healed by substituting the external fixation for implanted metalwork. Malunion occurred in 3 patients and delayed union occurred in 4 patients. Posttraumatic arthritis was found in 10 patients with the radiographic examination, 2 of whom underwent arthrodesis because of the long-term pain and bad func_tion, others with the existence of arthritis have good function of the ankle. Conclusion The clinical outcomes of the treatment of trimalleolar fractures are satisfactory through the direct approach.