手法复位夹板外固定与切开复位内固定治疗三踝骨折的疗效比较  

A clinical comparison of manipulative reduction and splint external fixation versus open reduction and internal fixation for treatment of trimalleolar fractures

作　　者：汤智 熊辉[2] 姜升平 曹慎 蒲云青 张旭桥 周彪[2] TANG Zhi;XIONG Hui;JIANG Shengping;CAO Shen;PU Yunqing;ZHANG Xuqiao;ZH0U Biao(Xiangtan Hospital of Traditional Chinese Medicine,Xiangtan 411100,Hunan,China;Hunan Chinese Medical University,Changsha 410208,Hunan,China)

机构地区：[1]湖南省湘潭市中医医院,湖南湘潭411100 [2]湖南中医药大学,湖南长沙410208

出　　处：《中医正骨》2018年第3期27-30,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：湖南省自然科学基金项目(2017JJ2256)

摘　　要：目的:比较手法复位夹板外固定与切开复位内固定治疗三踝骨折的临床疗效。方法:2016年1—10月纳入三踝骨折患者60例,随机分为2组,每组30例。在口服桃红四物汤的基础上,分别采用手法复位夹板外固定和切开复位解剖钢板加空心钉内固定治疗。记录并比较2组患者的住院时间、下地时间、住院总费用、骨折愈合时间及治疗后1年的Baird-Jackson踝关节评分。结果:2组患者均顺利完成治疗。手法复位夹板外固定组较切开复位内固定组住院时间短、下地时间早、住院总费用少[(15.1±1.0)d,(21.3±1.4)d,t=-23.007,P=0.000;(28.2±1.6)d,(30.4±1.7)d,t=4.634,P=0.000;(5 183.4±551.9)元,(16 151.7±716.5)元,t=-65.631,P=0.000]。2组患者均获随访,随访时间1年;骨折均愈合,手法复位夹板外固定组骨折愈合时间较切开复位内固定组短[(3.10±0.2)个月,(3.53±0.5)个月,t=-3.317,P=0.004]。治疗后1年2组BairdJackson踝关节评分比较,组间差异无统计学意义[(92.2±1.8)分,(91.4±2.6)分,t=1.541,P=0.134]。结论:手法复位夹板外固定与切开复位内固定治疗三踝骨折,二者疗效相当,但前者骨折愈合时间短、住院时间短、下地时间早、住院费用低。Objective:To compare the clinical effects of manipulative reduction and splint external fixation versus open reduction and internal fixation in treatment of trimalleolar fractures.Methods:Sixty patients with trimalleolar fractures were included from January 2016 to October 2016 and were randomly divided into 2 groups,30 cases in each group.All of the patients were treated with oral application of Taohong Siwu T ang(桃红四物汤,THSWT)’m oreover,the patients were treated with manipulative reduction and splint external fixation(group A)and open reduction and internal fixation(group B)respectively.Hospital stay,bed rest tim e,total cost of hospitalization,fracture healing time and posttreatment Baird-Jackson ankle scores were recorded and compared between the 2 groups.Results:The treatment were finished successfully in all patients.The hospital stay and the bed rest time were shorter and the total cost of hospitalization was less in group A compared to group B(15.1+/-1.0 vs 2 1.3+/-1.4 days,t=-23.007=0.0 0 0;28.2+/-1.6 vs 30.4+/-1.7 days,t=4.634,P=0.0 0 0;5 183.4+/-5 5 1.9 vs 16 151.7+/-7 1 6.5 RMB,^=-6 5.631=0.0 0 0).All patients in the 2 groups were followed up for 1 year and all fractures healed.The fracture healing time was shorter in group A compared to group B(3.10+/-0.2 vs 3.53+/-0.5 months,t--3.3 1 7,P=0.0 04).There was no statistical difference in Baird-Jackson ankle scores between the 2 groups at one year after treatment(92.2+/-1.8 vs 9 1.4+/-2.6 points,t=1.541,P=0.1 3 4).Conclusion:Manipulative reduction and splint external fixation is similarto open reduction and internal fixation in the curative effects in treatment of trimalleolar fractures,while the former has the advantages of shorter fracture healing tim e,shorter hospital stay shorter bed rest timer and less total cost of hospitalization.

关 键 词：骨折 踝关节 正骨手法 小夹板固定 骨折固定术 内 桃红四物汤 

分 类 号：R687.3[医药卫生—骨科学]