摘要
目的:比较腓骨入路与后外侧入路钢板螺钉内固定治疗旋后外旋型踝关节骨折的临床疗效和安全性。方法:将符合要求的100例旋后外旋型踝关节骨折患者随机分为2组,每组50例,分别采用后外侧入路钢板螺钉内固定(后外侧入路组)和腓骨入路钢板螺钉内固定(腓骨入路组)治疗。记录并比较2组患者的手术时间、术中出血量、骨折愈合时间、住院时间、美国足与踝关节协会(American Orthopaedic Footand Ankle Society,AOFAS)踝与后足评分、简明健康状况调查表(shortform 36 health survey questionnaire,SF-36)评分、综合疗效和并发症发生情况。结果:①一般指标。2组患者的手术时间、术中出血量及住院时间比较,组间差异均无统计学意义[(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];后外侧入路组患者的骨折愈合时间短于腓骨入路组[(13.56±3.25)周,(17.24±4.12)周,t=-4.959,P=0.000]。②AOFAS踝与后足评分。时间因素和分组因素存在交互效应(F=18.350,P=0.000);2组患者的AOFAS踝与后足评分总体比较,组间差异有统计学意义,即存在分组效应(F=174.135,P=0.000);手术前后不同时间点AOFAS踝与后足评分的差异有统计学意义,即存在时间效应(F=486.458,P=0.000);2组患者的AOFAS踝与后足评分随时间变化均呈上升趋势,但2组的上升趋势不完全一致[(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];术前2组患者的AOFAS踝与后足评分比较,差异无统计学意义(t=-0.532,P=0.989);术后1个月、3个月、6个月、12个月,后外侧入路组患者的AOFAS踝与后足评分均高于腓骨入路组(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评分。术前2组患者的SF-36评分
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 m L,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 ±
作者
张碧文
ZHANG Biwen(Xianju People's Hospital,Xianju 317300,Zhejiang,China)
出处
《中医正骨》
2021年第6期15-20,41,共7页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
踝关节
关节内骨折
骨折固定术
内
手术入路
临床试验
ankle joint
intra-articular fractures
fracture fixation,internal
operative approach
clinical trial
