摘要
目的比较三种不同内固定方式治疗后踝骨折的临床疗效及并发症情况。方法回顾性分析2010-03/2015-01月作者医院收治的85例合并后踝骨折的踝关节骨折脱位病例,骨折按照Lauge-Hansen分型:旋后外旋型Ⅲ度8例,旋后外旋型Ⅳ度45例,旋前外旋型Ⅲ度5例,旋前外旋型Ⅳ度13例,旋前外展型Ⅳ度14例。依据内固定方式分为由后向前螺钉固定29例(A组)、后侧小T型钢板固定31例(B组)及由前向后经皮空心螺钉固定25例(C组)。记录每组手术并发症及骨折复位质量,末次随访按照美国骨科足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝后足评分标准评估临床疗效。结果术后随访18~48(27.67±8.36)个月,A组25例骨折获解剖复位,B组28例骨折获解剖复位,C组仅11例骨折获解剖复位;B组1例并发深部感染,5例并发踇长屈肌挛缩;C组7例螺钉偏入下胫腓联合,末次随访AOFAS评分组间差异无统计学意义(P>0.05);并发症发生率,A组为6.90%,B组为29.03%,C组为44.00%,组间比较差异有统计学意义(P<0.05)。结论由后向前螺钉固定治疗后踝骨折临床疗效良好,较由前向后经皮螺钉固定和后侧小T型钢板固定并发症发生率低。
Objective To compare the clinical effects and complications of three different internal fixation methods for posterior malleolus fracture. Methods Eighty-five ankle facture-dislocation patients combined with posterior malleolus fracture in authoI＇s hospital were retrospectively reviewed from March 2010 to January 2015. Of the 85 fractures that fit into Lauge-Hansen categories, 8 were classified as supination-external rotation type III, 45 were supination-external rotation type IV, 5 were pronation-external rotation type III, 13 were pronation-external rotation type IV, and 14 were pronation-abduction type IV. Patients were divided into three groups according to internal fixation methods： 29 patients with posterior-anterior screw fixation were group A, 31 patients with posterior T-type plating were group B, 25 patients with anterior-posterior hollow screw fixation were group C. After the surgeries, complications and reduction qualities in each group were recorded, and clinical outcomes were evaluated at the lastest follw-up by American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot scale. Results The followed-up were average （27. 67 ± 8. 36） months, ranged 18- 48. The postoperative reductions were as follows： 25 in group A, 28 in group B, 11 in group C. There were I patient with deep infection and 5 patients with contracture of flexor hallucis longus muscles in group B, meanwhile 7 patients with malposition of lag screws in group C. AOFAS scores were no significant difference at last follow-up between groups （P〉0. 05）. The complication rates of group A, B and C were 6. 90%, 29. 03% and 44. 00%, respectively （P〈0. 05）. Conclusion The posterior-anterior screw fixation on the treatment of posterior malrleolus fracture has better clinical outcomes and less complications than posterior T-type plating or anterior-posterior screw fixation.
出处
《华南国防医学杂志》
CAS
2017年第2期108-111,共4页
Military Medical Journal of South China
基金
武汉市中青年医学骨干人才培养计划资助项目(武卫生计生[2014]77号)
关键词
踝关节
骨折
骨折内固定术
对照研究
Ankle joint
Fracture
Internal fixation
Comparison study
