切开复位内固定治疗开放与闭合踝关节Logsplitter骨折疗效比较  

Effectiveness comparison of open reduction and internal fixation for open and closed ankle Logsplitter fractures

作　　者：任毅[1,2] 吴仕舟 邓伟[3] 宋润来 董洪先[3] 李亚星[3] 陈宇[3] 刘运杰 黄富国[3] 张晖[2,3] REN Yi;WU Shizhou;DENG Wei;SONG Runlai;DONG Hongxian;LI Yaxing;CHEN Yu;LIU Yunjie;HUANG Fuguo;ZHANG Hui(West China School of Medicine,Sichuan University,Chengdu Sichuan,610041,P.R.China;Disaster Medical Center,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China 4.West China School of Public Health,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学灾难医学中心,成都610041 [3]四川大学华西医院骨科,成都610041 [4]四川大学华西公共卫生学院,成都610041

出　　处：《中国修复重建外科杂志》2018年第10期1302-1307,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨切开复位内固定治疗高能量踝关节Logsplitter骨折的临床疗效,并比较开放与闭合Logsplitter骨折患者预后差异。方法回顾分析2011年4月—2016年5月采用切开复位内固定治疗的36例Logsplitter骨折患者临床资料。其中15例为开放骨折脱位(开放组),21例为闭合骨折脱位(闭合组)。两组患者性别、年龄、合并伤、受伤至入院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。术后随访观察患者切口愈合、踝关节活动度恢复、并发症发生及骨折愈合情况等。采用美国矫形足踝协会(AOFAS)评分对患者术后踝关节功能进行评价。结果两组患者均获随访,随访时间12~29个月,平均19个月;开放组和闭合组随访时间比较差异无统计学意义(t=1.169,P=0.251)。开放组出现术后感染3例,骨折不愈合3例,创伤后骨关节炎5例;闭合组分别有1例出现上述并发症;两组除创伤后骨关节炎发生率比较差异有统计学意义(P=0.02)外,其余并发症发生率比较差异均无统计学意义(P=0.41)。末次随访时两组AOFAS评分比较差异无统计学意义(t=1.981,P=0.056);开放组获良10例、一般5例,闭合组获良13例、一般8例,两组比较差异亦无统计学意义(P=0.796)。两组骨折愈合患者的愈合时间以及踝关节跖屈、背伸、内翻、外翻活动度比较差异均无统计学意义(P>0.05)。结论对开放或闭合Logsplitter骨折实施切开复位内固定术均可获得较满意疗效,有效减少并发症发生率,提高患者的踝关节功能。Objective To investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries（a kind of transsyndesmotic ankle fracture dislocation）, and compare the prognosis between open and closed Logsplitter fracture. Methods The clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation（open group） and 21 cases were closed fracture and dislocation（closed group）. There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time（P0.05）,with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society（AOFAS） score.Results Both groups were followed up 12-29 months（mean, 19 months）. There was no significant difference in the follow-up time between the open group and the closed group（t=1.169, P=0.251）. In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; each mentioned complications had 1 case in the closed group; there was no significant difference in complications incidence between the two groups（P=0.41） except post-traumatic osteoarthritis incidence（P=0.02）. At last follow-up, there was no significant difference in AOFAS score between the two groups（t=1.981, P=0.056）. According to AOFAS score criterion, the results were good in10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference（P=0.796）. There was no significant difference in the union duration and ankle flexion, dorsal extension, varus, and valgus motion between the two groups（P〉0.05）. Conclusion Open reduction and internal fixation for open or closed

关 键 词：Logsplitter骨折 踝关节骨折 切开复位内固定 下胫腓联合 

分 类 号：R687.3[医药卫生—骨科学]