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[1]劉駿逸,劉曉東,李朝暉.腓骨入路與踝關(guān)節(jié)后外側(cè)入路切開(kāi)復(fù)位內(nèi)固定治療踝關(guān)節(jié)旋后外旋型Ⅳ度骨折的對(duì)比研究[J].中醫(yī)正骨,2021,33(09):15-19.
　LIU Junyi,LIU Xiaodong,LI Zhaohui.A comparative study of open reduction and internal fixation through fibular approach versus malleolar posterolateral approach for treatment of supination-extorsion-type grade Ⅳankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(09):15-19.
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腓骨入路與踝關(guān)節(jié)后外側(cè)入路切開(kāi)復(fù)位內(nèi)固定治療踝關(guān)節(jié)旋后外旋型Ⅳ度骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年09期
頁(yè)碼:
15-19
欄目:
臨床研究
出版日期:
2021-09-20

文章信息/Info

Title:
A comparative study of open reduction and internal fixation through fibular approach versus malleolar posterolateral approach for treatment of supination-extorsion-type grade Ⅳankle fractures
作者:
劉駿逸; 劉曉東; 李朝暉
(河南省洛陽(yáng)正骨醫(yī)院/河南省骨科醫(yī)院,河南 鄭州 450016)
Author(s):
LIU Junyi; LIU Xiaodong; LI Zhaohui
Luoyang Orthopedic-Traumatological Hospital,Zhengzhou 450016,Henan,China
關(guān)鍵詞:
踝關(guān)節(jié);  骨折固定術(shù); 內(nèi);  手術(shù)入路;  臨床試驗(yàn)
Keywords:
ankle joint;  fracture fixation; internal;  operative approach;  clinical trial
摘要:
目的:比較腓骨入路與踝關(guān)節(jié)后外側(cè)入路切開(kāi)復(fù)位內(nèi)固定治療踝關(guān)節(jié)旋后外旋型Ⅳ度骨折的臨床療效及安全性。方法:回顧性分析2014年1月至2018年1月收治的122例踝關(guān)節(jié)旋后外旋型Ⅳ度骨折患者的病例資料,患者均采用切開(kāi)復(fù)位內(nèi)固定治療,其中43例采用腓骨入路(腓骨入路組)、79例采用踝關(guān)節(jié)后外側(cè)入路(后外側(cè)入路組)。記錄手術(shù)時(shí)間、術(shù)中出血量,采用Burwell-Charnley放射學(xué)復(fù)位標(biāo)準(zhǔn)評(píng)價(jià)術(shù)后1周CT檢查的踝關(guān)節(jié)復(fù)位質(zhì)量,采用美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)術(shù)后12個(gè)月的綜合療效,觀察并發(fā)癥發(fā)生情況。結(jié)果:2組患者手術(shù)時(shí)間、術(shù)中出血量及術(shù)后12個(gè)月的AOFAS踝與后足評(píng)分比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(108.73±14.95)min,(111.75±11.67)min,t=1.279,P=0.763;(189.93±38.46)mL,(201.27±31.88)mL,t=1.593,P=0.126;(89.17±5.12)分,(91.31±4.77)分,t=0.768,P=0.313]。腓骨入路組的復(fù)位質(zhì)量?jī)?yōu)40例、中3例,后外側(cè)入路組的復(fù)位質(zhì)量?jī)?yōu)61例、中18例,腓骨入路組的復(fù)位質(zhì)量?jī)?yōu)于后外側(cè)入路組(χ2=4.883,P=0.027)。2組患者均未出現(xiàn)切口深層感染及骨折不愈合。腓骨入路組出現(xiàn)2例切口淺表感染、1例小腿肌間靜脈血栓,后外側(cè)入路組出現(xiàn)3例切口淺表感染、2例切口裂開(kāi)、1例腓腸神經(jīng)損傷、2例小腿肌間靜脈血栓; 2組患者并發(fā)癥發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.337,P=0.803)。結(jié)論:腓骨入路與踝關(guān)節(jié)后外側(cè)入路切開(kāi)復(fù)位內(nèi)固定治療踝關(guān)節(jié)旋后外旋型Ⅳ度骨折,在手術(shù)時(shí)間、術(shù)中出血量、綜合療效及并發(fā)癥發(fā)生率方面無(wú)明顯差異,但采用腓骨入路可以獲得更好的復(fù)位效果。
Abstract:
Objective:To compare the clinical curative effects and safety of open reduction and internal fixation through fibular approach(FA)versus malleolar posterolateral approach(PLA)for treatment of supination-extorsion-type grade Ⅳ ankle fractures.Methods:The medical records of 122 patients with supination-extorsion-type grade Ⅳ ankle fractures recruited from January 2014 to January 2018 were analyzed retrospectively.Forty-three patients were treated with open reduction and internal fixation through FA(FA group)and 79 ones with open reduction and internal fixation through malleolar PLA(PLA group).The operative time and intraoperative blood loss were recorded and compared between the 2 groups.The ankle reduction outcome checked by CT at 1 week after the surgery was evaluated by using Burwell-Charnley radiological reduction criteria.The total curative effects was evaluated by using American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores at 12 months after the surgery,and the complications were observed.Results:There was no statistical difference in operative time,intraoperative blood loss and AOFAS ankle-hindfoot scores measured at 12 months after the surgery between the 2 groups(108.73±14.95 vs 111.75±11.67 minutes,t=1.279,P=0.763; 189.93±38.46 vs 201.27±31.88 mL,t=1.593,P=0.126; 89.17±5.12 vs 91.31±4.77 points,t=0.768,P=0.313).The ankle reduction outcome was evaluated according to Burwell-Charnley radiological reduction criteria,40 patients got an excellent result and 3 fair in FA group; while 61 patients obtained an excellent result and 18 fair in PLA group.The ankle reduction outcome was better in FA group compared to PLA group(χ2=4.883,P=0.027).The complications such as deep incision infection and fracture nonunion were unfound in the 2 groups; whereas the superficial incision infection(2 cases)and intramuscular calf vein thrombosis(1 case)were found in FA group,and the superficial incision infection(3 cases),incision dehiscence(2 cases),sural nerve injuries(1 case)and intramuscular calf vein thrombosis(2 cases)were found in PLA group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.337,P=0.803).Conclusion:There is no obvious difference in operative time,intraoperative blood loss,total curative effects and complication incidence between FA and malleolar PLA in open reduction and internal fixation for treatment of supination-extorsion-type grade Ⅳ ankle fractures,however,the former has such advantages as better ankle reduction outcome.

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更新日期/Last Update: 1900-01-01