摘要
目的通过分析微型锁定钢板与无头空心螺钉在斜型内踝骨折治疗中的临床疗效,为临床提供最佳的治疗方案。方法回顾性分析第二军医大学附属长海医院2013年4月—2015年1月共收治内踝骨折患者44例,男性27例,女性17例;年龄20~67岁,平均(42.6±6.3)岁。致伤原因:扭伤23例,运动伤16例,交通伤5例。合并伤:双踝骨折7例,三踝骨折5例,所有骨折均为闭合性损伤;受伤至手术时间:4 h^3 d;按照内固定选择不同分为2组:A组18例,采用微型锁定钢板固定;B组26例,采用无头空心螺钉固定;通过门诊随访及X线片评定骨折愈合率、并发症发生率及美国足与踝关节协会踝与后足功能评分(AOFAS ankle-hindfoot scale)。结果 44例患者术后获12~18个月随访,平均(13.9±0.4)个月;骨折愈合时间10~16周,平均(12.4±0.9)周,无伤口感染及愈合不良,无内固定断裂、松动、骨折不愈合等并发症发生;按照AOFAS踝与后足功能评分,A组评分平均为(92.8±5.6)分,B组评分平均为(93.0±4.7)分,较术前2组功能均显著提高,但2组间比较评分差异无统计学意义(P>0.05)。结论对于斜型内踝骨折,微型锁定钢板与无头空心螺钉都可以提供有效的断端加压及较好的临床结果,但无头空心螺钉具有费用低、可经皮复位骨折、软组织剥离较少等优点,是一种安全有效的方法,值得临床推广应用。
Objective The effects of micro-locking plate and headless compression screw in oblique fracture of the medial malleolus were compared to provide optimal therapeutic plans. Methods A total of 44 medial malleolus fracture in our hospital from April ,2013 to January ,2015, including 27 males and 17 females, age raged from 20 to 67 years old with average of （42.6 ±26.3 ）years old, were retrospectively analyzed. The causes of fracture included sprain（ n = 23 ） , sports in- jury（ n = 16） and traffic injury（ n = 5 ）. For combined injuries ,there were 7 cases with double ankle fractures and 5 cases with trimalleolar fracture. All fractures were close injuries. The durations from injuries to operations were 4 h to 3 d. Based on different options for internal fixation, the patients were divided into two group, Group A （ n = 18 ; fixation with micro-locking plate） and Group B （n = 26 ;fixation with headless cannulated screw）. The fracture healing rate, incidence of complications,and the American foot and Ankle Society ankle hindfoot score（ AOFAS Ankle-Hindfoot Scale） were evaluated by outpatient follow-up and X-ray. Results All 44 patients were followed up for 12 - 18 months [ an average of （ 13.9 ±3.4） months]. The fracture healing time was 10 - 16 weeks with an average of （ 12.4 ±0.9） weeks. There was no case with wound infection and poor healing and no complications, such as breakage or Loosening of internal fixation, and nonunion of fractures. According to AOFAS ankle and hindfoot score,the average score of group A and group B was 92.8 ±5.6 and 93.0 ±4.7 points respectively. Compared with the preoperative, the functional score significantly increased. But it showed that there was no statistically significant difference between the two groups（ P 〉 0. 05 ）. Condusion For oblique fracture of the medial malleolus, both micro-locking plate and headless compression screw can provide effective stump pressure and better clinical results. However, screw technique shows superiorities
出处
《中华全科医学》
2017年第4期552-554,共3页
Chinese Journal of General Practice
基金
上海市卫生系统第二批联合攻关项目重点项目(2014ZYJB000)
国家自然科学基金青年基金(81-501052)
关键词
内踝骨折
无头加压螺钉
踝关节骨折
康复
Medial malleolar fracture
Headless compression screws
Ankle fracture
Recovery
