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[1]譚新歡,李嘉,楊慶民,等.手法復(fù)位經(jīng)皮穿針內(nèi)固定結(jié)合石膏外固定治療旋后外旋型Ⅱ度踝關(guān)節(jié)骨折的臨床研究[J].中醫(yī)正骨,2021,33(02):12-16.
　TAN Xinhuan,LI Jia,YANG Qingmin,et al.A clinical study of manipulative reduction and percutaneous Kirschner wire internal fixation combined with plaster external fixation for treatment of supination-extorsion-type gradeⅡankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(02):12-16.
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手法復(fù)位經(jīng)皮穿針內(nèi)固定結(jié)合石膏外固定治療旋后外旋型Ⅱ度踝關(guān)節(jié)骨折的臨床研究()
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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02期
頁碼:
12-16
欄目:
臨床研究
出版日期:
2021-02-20

文章信息/Info

Title:
A clinical study of manipulative reduction and percutaneous Kirschner wire internal fixation combined with plaster external fixation for treatment of supination-extorsion-type gradeⅡankle fractures
作者:
譚新歡; 李嘉; 楊慶民; 孫晉客; 聶偉志; 隋海明
(山東省文登整骨醫(yī)院,山東 威海 264400)
Author(s):
TAN Xinhuan; LI Jia; YANG Qingmin; SUN Jinke; NIE Weizhi; SUI Haiming
Shandong Wendeng Osteopathic Hospital,Weihai 264400,Shandong,China
關(guān)鍵詞:
骨折;  踝關(guān)節(jié);  骨折固定術(shù);  正骨手法
Keywords:
fractures; bone;  ankle joint;  fracture fixation;  bone setting manipulation
摘要:
目的:探討手法復(fù)位經(jīng)皮穿針內(nèi)固定結(jié)合石膏外固定治療旋后外旋型Ⅱ度踝關(guān)節(jié)骨折的臨床療效和安全性。方法:回顧性分析2013年3月至2019年1月收治的108例旋后外旋型Ⅱ度踝關(guān)節(jié)骨折患者的病例資料。根據(jù)治療方法分組,手法復(fù)位后采用克氏針經(jīng)皮穿針內(nèi)固定結(jié)合石膏外固定治療者分入聯(lián)合固定組,手法復(fù)位后單純采用石膏外固定治療者分入石膏外固定組,兩組各54例。比較兩組患者的骨折愈合時間、術(shù)后6周釆用Leeds影像學(xué)評價標(biāo)準(zhǔn)評價的骨折復(fù)位情況、術(shù)后1年采用Baird踝關(guān)節(jié)評分系統(tǒng)評價的踝關(guān)節(jié)功能以及并發(fā)癥發(fā)生情況。結(jié)果:108例患者均獲隨訪,隨訪時間12～14個月,中位數(shù)12.5個月。術(shù)后6周,聯(lián)合固定組骨折復(fù)位優(yōu)良50例、可4例,石膏外固定組骨折復(fù)位優(yōu)良38例、可13例、差3例; 聯(lián)合固定組骨折復(fù)位情況優(yōu)于石膏外固定組(Z=-3.006,P=0.003)。骨折均愈合,2組患者骨折愈合時間比較,差異無統(tǒng)計學(xué)意義[(8.47±1.59)周,(8.52±1.62)周,t=1.496,P=0.175]。術(shù)后1年,聯(lián)合固定組Baird踝關(guān)節(jié)評分高于石膏外固定組[(93.51±5.18)分,(84.18±4.32)分; t=8.483,P=0.011)。聯(lián)合固定組術(shù)后3周時出現(xiàn)針孔感染1例,經(jīng)換藥治療1周后感染控制; 聯(lián)合固定組6例患者和石膏外固定組9例患者術(shù)后1年踝關(guān)節(jié)僵硬、疼痛; 均無二次骨折、骨折再移位等并發(fā)癥發(fā)生; 2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.290,P=0.588)。結(jié)論:對于旋后外旋型Ⅱ度踝關(guān)節(jié)骨折,手法復(fù)位后采用克氏針經(jīng)皮穿針內(nèi)固定結(jié)合石膏外固定較單純采用石膏外固定,骨折復(fù)位好、更有利于踝關(guān)節(jié)功能恢復(fù),但二者在骨折愈合時間和并發(fā)癥發(fā)生率方面無明顯差異。
Abstract:
To explore the clinical curative effects and safety of manipulative reduction and percutaneous Kirschner wire internal fixation combined with plaster external fixation for treatment of supination-extorsion-type gradeⅡankle fractures.Methods:The medical records of 108 patients with supination-extorsion-type gradeⅡankle fractures recruited from March 2013 to January 2019 were analyzed retrospectively.The patients were divided into combination fixation group and plaster external fixation group according to the treatment methods,54 cases in each group.All patients in the 2 groups were treated with manipulative reduction; moreover,the patients in combination fixation group were treated with percutaneous Kirschner wire internal fixation and plaster external fixation,and the patients in plaster external fixation group were treated with plaster external fixation.The fracture healing time,fracture reduction result evaluated by using Leeds imaging evaluation standard at 6 weeks after the surgery,ankle function evaluated by using Baird ankle scoring system at 1 year after the surgery and complication incidence were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 12-14 months with a median of 12.5 months.The results of fracture reduction evaluated at 6 weeks after the surgery showed that 50 patients obtained a good result and 4 fair in combination fixation group; while 38 patients obtained a good result,13 fair and 3 poor in plaster external fixation group.The results of fracture reduction were better in combination fixation group compared to plaster external fixation group(Z=-3.006,P=0.003).All fractures healed in the 2 groups,and there was no statistical difference in the fracture healing time between the 2 groups(8.47±1.59 vs 8.52±1.62 weeks,t=1.496,P=0.175).The Baird ankle scores were higher in combination fixation group compared to plaster external fixation group at 1 year after the surgery(93.51±5.18 vs 84.18±4.32 points,t=8.483,P=0.011).The pinhole infections(1 case)were found in combination fixation group at 3 weeks after the surgery,and the infections were controlled after 1-week treatment with dressing change.Ankle ankylosis and pain were found in 6 patients in combined fixation group and 9 patients in plaster external fixation group at 1 year after the surgery.No complications such as refractures and fracture re-displacements were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(χ2=0.290,P=0.588).Conclusion:After manipulative reduction,the combination therapy of percutaneous Kirschner wire internal fixation and plaster external fixation is more conducive to the ankle fracture reduction and ankle function recovery compared to the monotherapy of plaster external fixation in treatment of supination-extorsion-type grade Ⅱ ankle fractures.However,there is no obvious difference in fracture healing time and complication incidence between the two therapies.

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通訊作者:隋海明 E-mail:[email protected]
更新日期/Last Update: 2021-02-20