支撑钢板与螺钉固定治疗旋后-内收型Ⅱ度踝关节骨折的比较研究  

Comparative study on screw or buttress plate for fixation of supination-adduction type-Ⅱ medial malleolar fracture

作　　者：赵宏谋[1] 张言[1] 胡东[1] 梁晓军[1] 李毅[1] 鹿军[1] 王军虎[1] 

机构地区：[1]西安交通大学医学院附属红会医院足踝外科,西安710054

出　　处：《中国修复重建外科杂志》2017年第5期553-558,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81301604);陕西省自然科学基金资助项目(2014JQ4164)~~

摘　　要：目的通过回顾性病例对照研究,探讨旋后-内收型Ⅱ度踝关节骨折中采用支撑钢板与螺钉固定内踝骨折的疗效差异,为临床选择内固定方式提供参考。方法回顾分析2009年3月—2012年12月收治并符合选择标准的53例旋后-内收型Ⅱ度踝关节骨折患者临床资料,根据内踝骨折固定方法进行分组,其中支撑钢板固定组30例、螺钉固定组23例。两组患者性别、年龄、骨折侧别、致伤原因、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后观察两组相关并发症发生情况,记录患者完全负重时间;采用美国矫形足踝协会(AOFAS)踝与后足评分标准进行临床疗效评估;疼痛视觉模拟评分(VAS)评估患者负重及行走时疼痛情况。复查踝关节正侧位X线片,评估骨折复位及愈合情况。记录手术失败例数。结果术后两组切口相关并发症发生率、感染发生率比较,差异均无统计学意义(P>0.05)。两组患者均获随访,支撑钢板固定组随访时间46~91个月,平均64.5个月;螺钉固定组为44~86个月,平均59.5个月。支撑钢板固定组患者术后完全负重时间较螺钉固定组显著缩短(t=2.05,P=0.04)。X线片复查示,除螺钉固定组2例骨折畸形愈合、1例不愈合外,两组其余患者骨折均获解剖复位并达骨性愈合;两组骨折愈合时间比较差异无统计学意义(t=1.06,P=0.30)。两组创伤性关节炎发生率、手术失败率以及末次随访时AOFAS评分及其优良率、VAS评分比较,差异均无统计学意义(P>0.05)。结论旋后-内收型Ⅱ度踝关节骨折中的内踝骨折由于骨折线与胫骨轴线夹角较小,单纯螺钉固定强度不足;而支撑钢板固定可以提供较大力学强度,患者可早期负重锻炼,临床疗效肯定。Objective To investigate the functional outcomes of buttress plate fixation and simple screws fixation for the treatment of supination-adduction type-II medial malleolar fractures so as to provide reference for selection of internal fixation. Methods Between March 2009 and December 2012, 53 patients with supination-adduction type-II medial malleolar fractures were treated with open reduction and internal fixation. Of them, buttress plate fixation was used in 30 cases （buttress plate fixation group）, and screws fixation was used in 23 cases （screw fixation group）. There was no significant difference in age, gender, injury cause, injury side, disease duration, and combined injuries between 2 groups （P〉0.05）. Complications and full weight-bearing time were recorded; the American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and the visual analogue scale （VAS） were used to evaluate the functional outcomes. Post-operative anteroposterior and lateral X-ray films were taken to evaluate fracture reduction and union condition. And the treatment failures were recorded. Results There was no significant difference in incision related complication rate and infection rate between 2 groups （P〉0.05）. The patients were followed up 46-91 months （mean, 64.5 months） in buttress plate fixation group and 44-86 months （mean, 59.5 months） in screw fixation group. The full weight-bearing time of the buttress plate fixation group was significantly shorter than that of screw fixation group （t=2.05,P=0.04）. During follow-up time, malunion and nonunion occurred in 2 cases and 1 case of screw fixation group; anatomic reduction and bony union were observed in the other patients of 2 groups. The union time showed no significant difference between 2 groups （t=1.06,P=0.30）. No significant difference was found in AOFAS score and good and excellent rate, VAS score, operation failure rate, and traumatic osteoarthritis rate between groups （P〉0.05）. Conclusion For patients with supina

关 键 词：踝关节骨折 旋后-内收型 内踝骨折 内固定 

分 类 号：R687.32[医药卫生—骨科学]