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[1]楊威,敖傳西,華賢章.非手術(shù)療法和手術(shù)療法治療B2型踝關(guān)節(jié)骨折的對(duì)比研究[J].中醫(yī)正骨,2013,25(04):15-17.
　YANG Wei*,AO Chuan-xi,HUA Xian-zhang.*.A retrospective trial of non-operative treatment versus operative treatment for type B2 ankle joint fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(04):15-17.
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非手術(shù)療法和手術(shù)療法治療B2型踝關(guān)節(jié)骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期數(shù):
2013年04期
頁(yè)碼:
15-17
欄目:
足踝損傷
出版日期:
2013-04-30

文章信息/Info

Title:
A retrospective trial of non-operative treatment versus operative treatment for type B2 ankle joint fractures
作者:
楊威; 敖傳西; 華賢章
湖北省恩施自治州中心醫(yī)院,湖北 恩施 445000
Author(s):
YANG Wei*; AO Chuan-xi; HUA Xian-zhang.*
Central Hospital of Enshi Autonomous Prefecture,Enshi 445000,Hubei,China
關(guān)鍵詞:
踝關(guān)節(jié) 骨折 骨牽引復(fù)位法 薰洗 切開(kāi)復(fù)位內(nèi)固定 回顧性研究
Keywords:
Ankle joint;  Fractures; bone;  Skeletal tracting reposition;  Steaming washing therapy;  Open reduction and internal fixation;  Retrospective studies
摘要:
目的:比較非手術(shù)療法和手術(shù)療法治療B2型踝關(guān)節(jié)骨折的臨床療效和安全性。方法:回顧性分析33例B2型踝關(guān)節(jié)骨折患者的病歷資料,采用手法復(fù)位“U”形石膏固定及中藥薰洗治療者17例(A組),采用切開(kāi)復(fù)位內(nèi)固定及中藥薰洗治療者16例(B組)。采用Leeds骨折復(fù)位評(píng)定標(biāo)準(zhǔn)比較2組患者的骨折復(fù)位情況,采用Yoshikawa骨痂生長(zhǎng)評(píng)分標(biāo)準(zhǔn)比較2組患者的骨折愈合情況,采用Mazur踝關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)比較2組患者的踝關(guān)節(jié)功能,同時(shí)比較2組患者治療后并發(fā)癥發(fā)生情況。結(jié)果:①骨折復(fù)位情況。A組優(yōu)16例,良1例; B組優(yōu)16例。2組患者骨折復(fù)位情況比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(u=128.000,P=0.332)。②骨折愈合情況。2組患者的骨折均在8周內(nèi)臨床愈合。治療后不同時(shí)間點(diǎn)骨痂生長(zhǎng)評(píng)分不同(F=697.140,P=0.000); 2組骨痂生長(zhǎng)評(píng)分總體有差別(F=8.208,P=0.007),進(jìn)一步比較顯示治療后4周、6周、12周A組骨痂生長(zhǎng)均優(yōu)于B組[(1.66±0.46)分,(1.21±0.30)分,t=3.295,P=0.002;(2.78±0.63)分,(2.37±0.42)分,t=2.235,P=0.033;(3.78±0.47)分,(3.39±0.41)分,t=2.531,P=0.016]; 時(shí)間因素與分組因素不存在交互效應(yīng)(F=0.125,P=0.831)。③踝關(guān)節(jié)功能。A組踝關(guān)節(jié)功能Mazur評(píng)分為(94.53±2.10)分,B組為(93.56±2.50)分,2組患者踝關(guān)節(jié)功能比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.206,P=0.237)。④并發(fā)癥。2組患者均獲隨訪,隨訪時(shí)間6～12個(gè)月,中位數(shù)8個(gè)月。A組患者治療后未出現(xiàn)骨折再移位等并發(fā)癥,B組所有患者的切口均甲級(jí)愈合,未發(fā)生感染、內(nèi)固定失敗等并發(fā)癥。結(jié)論:對(duì)于B2型踝關(guān)節(jié)骨折,非手術(shù)療法和手術(shù)療法在復(fù)位骨折及恢復(fù)踝關(guān)節(jié)功能方面療效相當(dāng),兩種療法的安全性也無(wú)明顯差異,但非手術(shù)療法更有利于骨痂生長(zhǎng)。
Abstract:
Objective:To compare the clinical curative effects and safety between non-operative treatment and operative treatment for type B2 ankle joint fractures.Methods:The clinical records of 33 patients with type B2 ankle joint fractures were analyzed retrospectively.Seventeen patients(group A)were administrated with manipulative reduction and U-shape plaster fixation combined with Chinese medicine steaming washing therapy,while the others(group B)were administrated with open reduction and internal fixation combined with Chinese medicine steaming washing therapy.The fracture reductions were compared between the 2 groups according to Leeds evaluation criteria for fracture reduction,the fracture healing status were compared between the 2 groups according to Yoshikawa scoring criteria for bony callus growth and the ankle joint functions were compared between the 2 groups according to Mazur scoring standard for ankle joint functions.Meanwhile,the posttreatment complications were compared between the 2 groups.Results:Sixteen patients achieved an excellent fracture reduction and 1 fair in group A,while 16 patients achieved an excellent fracture reduction in group B.There was no statistical difference in the result of fracture reduction between the 2 groups(u=128.000,P=0.332).All of the patients in the 2 groups got fracture healing within 8 weeks.There was statistical difference in the bony callus growth scores among posttreatment time points(F=697.140,P=0.000); and there was statistical difference in the bony callus growth scores between the 2 groups totally(F=8.208,P=0.007).Further comparision showed that the bony callus growth scores of group A were higher than those of group B at 4 weeks,6 weeks and 12 weeks after treatment respectively((1.66±0.46),(1.21±0.30),t=3.295,P=0.002;(2.78±0.63),(2.37±0.42),t=2.235,P=0.033;(3.78±0.47),(3.39±0.41),t=2.531,P=0.016).There was no interaction between time factor and grouping factor(F=0.125,P=0.831).There was no statistical difference in Mazur ankle performance scores between the 2 groups((94.53±2.10),(93.56±2.50); t=1.206,P=0.237).All of the patients in the 2 groups were followed up for 6-12 months with a median of 8 months.After treatment,no patients with fracture displacement and other complications were found in group A.All of the patients in group B got primary healing in the operative incisions and no complications such as infection and failed internal fixation were found in group B.Conclusion:For type B2 ankle joint fractures,non-operative treatment and operative treatment have similar curative effects on fracture reduction and ankle joint function restoration,and they are similar to each other in safety,while the former is more helpful to bony callus growth.

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備注/Memo

備注/Memo:
2012-12-24收稿 2013-01-25修回
通訊作者:楊威 E-mail:[email protected]
更新日期/Last Update: 2013-04-30