摘要
目的 探究螺旋形胫骨下1/3骨折伴后踝骨折(PMF)患者经髓内钉(半伸直位)+空心螺钉(OCS)固定治疗的效果。方法 回顾性收集我院78例螺旋形胫骨下1/3骨折伴PMF患者(2020年1月—2021年12月)病例资料,按手术方案不同分2组。以接受髓内钉(半伸直位)+OCS固定治疗的39例患者列为A组,以接受标准髓内钉+OCS固定治疗的39例患者列为B组。对比2组手术指标、手术效果、手术前后Karlsson踝关节功能评分(KAFS)、美国纽约特种外科医院评分(HSS)、疼痛介质[β-内啡肽(β-EP)、P物质(SP)、5-羟色胺(5-HT)]、并发症发生率。结果 A组术中失血量、骨折愈合时间、住院用时相较于B组无明显差异(P>0.05);A组手术用时相较于B组更短(P<0.05);术后6个月2组HSS、KAFS评分相较于术前比较,差异有统计学意义(P<0.05),但A组术后6个月HSS、KAFS评分相较于B组比较,差异无统计学意义(P>0.05);A组手术优良率97.44%(38/39)相较于B组92.31%(36/39)比较,差异无统计学意义(P>0.05);A组术后1d血清β-EP、SP、5-HT水平相较于B组更低(P<0.05);A组并发症发生率5.13%(2/39)相较于B组12.82%(5/39)比较,差异无统计学意义(P>0.05)。结论 螺旋形胫骨下1/3骨折伴PMF经髓内钉(半伸直位)+OCS固定与标准髓内钉+OCS固定治疗,在手术效果、安全性及促进膝关节、踝关节功能方面效果相当,但前者能进一步缩短手术用时,避免机体疼痛介质过度释放。
Objective To investigate the effect of intramedullary nail(semi-straightening)+hollow screw(OCS)fixa-tion on spiral tibial lower 1/3 fracture with posterior malleolar fracture(PMF).Methods The data of 78 patients with spi-ral tibial lower 1/3 fracture complicated with PMF(January 2020~December 2021)in our hospital were retrospectively col-lected and divided into 2 groups according to different surgical protocols.Thirty-nine patients receiving intramedullary nail-ing(semi-extension)+OCS fixation were classified as group A,and 39 patients receiving standard intramedullary nailing+OCS fixation were classified as group B.Surgical indexes,surgical effect,Karlsson Ankle function score(KAFS)before and after surgery,Hospital for Special Surgery Score(HSS),pain mediators[β-endorphin(β-EP),Substance P(SP),5-hydroxytryptamine(5-HT)] and complication rate were compared between the two groups.Results The intraoperative blood loss,fracture healing time and hospitalization time in group A were not significantly different from those in group B(P>0.05).The operation time of group A was shorter than that of group B(P<0.05).significance compared with those before surgery(P<0.05),but there was no statistical significance in HSS and KAFS scores of the 2 groups compared with those of the 2 groups before surgery(P>0.05).The excellent and good rate of operation in group A was 97.44%(38/39)compared with 92.31%(36/39)in group B,and there was no statistical significance(P>0.05).Serumβ-EP,SP and 5-HT levels in group A were lower than those in group B at 1 day after operation(P<0.05).The incidence of complications in group A was 5.13%(2/39)compared with 12.82%(5/39)in group B,with no statistical significance(P>0.05).Conclusion PMF fixation with intramedullary nailing(semi-extended)and OCS fixation is comparable to standard intramedullary nailing and OCS fixation in terms of surgical efficacy,safety and promoting the function of knee joint and ankle joint,but the former can further shorten the operation time and avoid excessive release of
作者
王浩宇
Wang Haoyu(Shangqiu Changzheng People's Hospital,Henan Shangqiu 476000)
出处
《辽宁医学杂志》
2024年第6期53-56,共4页
Medical Journal of Liaoning
关键词
后踝骨折
半伸直位
疼痛介质
螺旋形胫骨下1/3骨折
髓内钉
Posterior malleolar fracture
Semi-straight position
Pain mediators
Spiral tibia lower 1/3 fracture
Intr-amedullary nail
