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[1]張碧文.腓骨入路與后外側(cè)入路鋼板螺釘內(nèi)固定治療旋后外旋型踝關(guān)節(jié)骨折的對比研究[J].中醫(yī)正骨,2021,33(06):15-20+41.
　ZHANG Biwen.A comparative study of internal fixation with steel plates and screws through fibular approach versus posterolateral approach for treatment of supination-extorsion-type ankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(06):15-20+41.
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腓骨入路與后外側(cè)入路鋼板螺釘內(nèi)固定治療旋后外旋型踝關(guān)節(jié)骨折的對比研究()
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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06期
頁碼:
15-20+41
欄目:
臨床研究
出版日期:
2021-06-20

文章信息/Info

Title:
A comparative study of internal fixation with steel plates and screws through fibular approach versus posterolateral approach for treatment of supination-extorsion-type ankle fractures
作者:
張碧文
仙居縣人民醫(yī)院,浙江 仙居 317300
Author(s):
ZHANG Biwen
Xianju People's Hospital,Xianju 317300,Zhejiang,China
關(guān)鍵詞:
踝關(guān)節(jié);  關(guān)節(jié)內(nèi)骨折;  骨折固定術(shù); 內(nèi);  手術(shù)入路;  臨床試驗
Keywords:
ankle joint;  intra-articular fractures;  fracture fixation; internal;  operative approach;  clinical trial
摘要:
目的:比較腓骨入路與后外側(cè)入路鋼板螺釘內(nèi)固定治療旋后外旋型踝關(guān)節(jié)骨折的臨床療效和安全性。方法:將符合要求的100例旋后外旋型踝關(guān)節(jié)骨折患者隨機分為2組,每組50例,分別采用后外側(cè)入路鋼板螺釘內(nèi)固定(后外側(cè)入路組)和腓骨入路鋼板螺釘內(nèi)固定(腓骨入路組)治療。記錄并比較2組患者的手術(shù)時間、術(shù)中出血量、骨折愈合時間、住院時間、美國足與踝關(guān)節(jié)協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評分、簡明健康狀況調(diào)查表(short form 36 health survey questionnaire,SF-36)評分、綜合療效和并發(fā)癥發(fā)生情況。結(jié)果:①一般指標(biāo)。2組患者的手術(shù)時間、術(shù)中出血量及住院時間比較,組間差異均無統(tǒng)計學(xué)意義[(115.23±18.35)min,(110.56±15.46)min,t=1.376,P=0.172;(257.62±28.32)mL,(265.35±35.24)mL,t=-1.209,P=0.230;(19.32±3.45)d,(20.23±2.84)d,t=-1.440,P=0.153]; 后外側(cè)入路組患者的骨折愈合時間短于腓骨入路組[(13.56±3.25)周,(17.24±4.12)周,t=-4.959,P=0.000]。②AOFAS踝與后足評分。時間因素和分組因素存在交互效應(yīng)(F=18.350,P=0.000); 2組患者的AOFAS踝與后足評分總體比較,組間差異有統(tǒng)計學(xué)意義,即存在分組效應(yīng)(F=174.135,P=0.000); 手術(shù)前后不同時間點AOFAS踝與后足評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=486.458,P=0.000); 2組患者的AOFAS踝與后足評分隨時間變化均呈上升趨勢,但2組的上升趨勢不完全一致[(18.56±4.36)分,(42.62±7.82)分,(58.23±6.72)分,(71.28±5.40)分,(82.62±7.35)分,F=524.330,P=0.000;(19.25±5.30)分,(33.47±6.52)分,(45.37±6.25)分,(60.33±7.43)分,(70.34±6.84)分,F=278.400,P=0.000]; 術(shù)前2組患者的AOFAS踝與后足評分比較,差異無統(tǒng)計學(xué)意義(t=-0.532,P=0.989); 術(shù)后1個月、3個月、6個月、12個月,后外側(cè)入路組患者的AOFAS踝與后足評分均高于腓骨入路組(t=7.058,P=0.000; t=9.920,P=0.000; t=8.447,P=0.000; t=9.472,P=0.000)。③SF-36評分。術(shù)前2組患者的SF-36評分比較,差異無統(tǒng)計學(xué)意義[(56.25±7.34)分,(55.13±6.82)分,t=0.790,P=0.431]; 術(shù)后12個月,后外側(cè)入路組患者的SF-36評分高于腓骨入路組[(78.63±6.37)分,(66.38±7.43)分,t=8.851,P=0.000],2組患者的SF-36評分均高于術(shù)前(t=-16.283,P=0.000; t=-7.888,P=0.000)。④綜合療效。術(shù)后12個月,后外側(cè)入路組優(yōu)10例、良16例、可12例、差12例,腓骨入路組優(yōu)18例、良23例、可8例、差1例; 后外側(cè)入路組患者的綜合療效優(yōu)于腓骨入路組(Z=-3.226,P=0.001)。⑤并發(fā)癥。后外側(cè)入路組患者術(shù)后出現(xiàn)踝關(guān)節(jié)腫脹3例、切口感染2例,腓骨入路組患者術(shù)后出現(xiàn)踝關(guān)節(jié)腫脹7例、切口感染5例、腓骨肌腱炎2例; 后外側(cè)入路組患者的并發(fā)癥發(fā)生率低于腓骨入路組(χ2=5.263,P=0.022)。結(jié)論:相較于腓骨入路鋼板螺釘內(nèi)固定,后外側(cè)入路鋼板螺釘內(nèi)固定治療旋后外旋型踝關(guān)節(jié)骨折,能更好地促進骨折愈合、改善踝關(guān)節(jié)功能、提高生活質(zhì)量,綜合療效好,安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of internal fixation with steel plates and screws through fibular approach(FA)versus posterolateral approach(PLA)for treatment of supination-extorsion-type ankle fractures.Methods:One hundred patients with supination-extorsion-type ankle fractures were enrolled in the study and were randomly divided into 2 groups,50 cases in each group,and they were treated with steel plates and screws internal fixation through PLA(PLA group)and FA(FA group)respectively.The operative time,intraoperative blood loss,fracture healing time,hospital stays,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores,short form 36 health survey questionnaire(SF-36)scores,total curative effects and complications were recorded and compared between the 2 groups.Results:There was no statistical difference in operative time,intraoperative blood loss and hospital stays between the 2 groups(115.23±18.35 vs 110.56±15.46 minutes,t=1.376,P=0.172; 257.62±28.32 vs 265.35±35.24 mL,t=-1.209,P=0.230; 19.32±3.45 vs 20.23±2.84 days,t=-1.440,P=0.153).The fracture healing time was shorter in PLA group compared to FA group(13.56±3.25 vs 17.24±4.12 weeks,t=-4.959,P=0.000).There was interaction between time factor and group factor in AOFAS ankle-hindfoot scores(F=18.350,P=0.000).There was statistical difference in AOFAS ankle-hindfoot scores between the 2 groups in general,in other words,there was group effect(F=174.135,P=0.000).There was statistical difference in AOFAS ankle-hindfoot scores between different timepoints before and after the surgery,in other words,there was time effect(F=486.458,P=0.000).The AOFAS ankle-hindfoot scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(18.56±4.36,42.62±7.82,58.23±6.72,71.28±5.40,82.62±7.35 points,F=524.330,P=0.000; 19.25±5.30,33.47±6.52,45.37±6.25,60.33±7.43,70.34±6.84 points,F=278.400,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups before the surgery(t=-0.532,P=0.989).The AOFAS ankle-hindfoot scores were higher in PLA group compared to FA group at 1,3,6 and 12 months after the surgery(t=7.058,P=0.000; t=9.920,P=0.000; t=8.447,P=0.000; t=9.472,P=0.000).There was no statistical difference in SF-36 scores between the 2 groups before the surgery(56.25±7.34 vs 55.13±6.82 points,t=0.790,P=0.431).The SF-36 scores were higher in PLA group compared to FA group at 12 months after the surgery(78.63±6.37 vs 66.38±7.43 points,t=8.851,P=0.000),and were higher at 12 months after the surgery compared to pre-surgery in the 2 groups(t=-16.283,P=0.000; t=-7.888,P=0.000).At 12 months after the surgery,10 patients obtained an excellent result,16 good,12 fair and 12 poor in PLA group; while 18 patients obtained an excellent result,23 good,8 fair and 1 poor in FA group.The PLA group surpassed FA group in the total curative effects(Z=-3.226,P=0.001).The ankle swelling(3 cases)and incision infection(2 cases)were found in PLA group; while ankle swelling(7 cases),incision infection(5 cases)and peroneal tendonitis(2 cases)were found in FA group.The incidence rate of postoperative complications was lower in PLA group compared to FA group(χ2=5.263,P=0.022).Conclusion:Internal fixation with steel plates and screws through PLA can better promote fracture healing as well as improve ankle function and patient's life quality compared to internal fixation with steel plates and screws through FA in treatment of supination-extorsion-type ankle fractures,and it exhibits better total curative effect and higher safety.

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備注/Memo:
通訊作者:張碧文 E-mail:[email protected]
更新日期/Last Update: 2021-12-20