不同方法置入拉力螺钉内固定治疗Haraguchi Ⅰ型后踝骨折的疗效比较  

Comparative study of different methods of lag screw fixation in the treatment of Haraguchi type Ⅰ posterior malleolus fracture

作　　者：梁承伟[1] 黄东辉[1] 刘伟[1] Liang Chengwei;Huang Donghui;Liu Wei(Department of Orthopaedics,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院骨科,上海200040

出　　处：《创伤外科杂志》2021年第7期516-519,共4页Journal of Traumatic Surgery

基　　金：上海市科委计划项目(15411951500)。

摘　　要：目的比较不同方法置入拉力螺钉内固定治疗Haraguchi Ⅰ型后踝骨折的疗效。方法回顾性分析2014年1月—2019年1月复旦大学附属华东医院骨科收治的Haraguchi Ⅰ型后踝骨折患者80例。男性36例,女性44例;年龄43~67岁,平均55.9岁;致伤原因:扭伤40例,道路交通伤31例,跌伤9例。按固定方法不同分为前后螺钉组(42例)和后前螺钉组(38例)。前后螺钉组经皮由前向后置入拉力螺钉内固定,后前螺钉组经后外侧入路直接置入拉力螺钉内固定。比较两组手术时间、骨折愈合时间和完全负重所需时间;采用踝关节Burwell-Charnley放射学评分比较两组患者踝关节面复位情况;采用美国足踝外科协会(AOFAS)评分评估两组患者术后6、12个月的踝关节功能;比较两组患者术后并发症发生情况。结果前后螺钉组的手术时间[(50.4±9.6)min]短于后前螺钉组[(68.5±12.8)min],P<0.05。两组完全负重所需时间比较[(13.1±1.4)周vs.(12.6±1.3)周]、骨折愈合时间比较[(12.5±1.6)周vs.(11.8±1.6)周],P>0.05。前后螺钉组的Burrwell-Charnley放射学评分优良率为76.2%,低于后前螺钉组的89.5%,差异有统计学意义(P<0.05)。术后6、12个月,前后螺钉组的AOFAS分别为(75.4±13.1)分和(80.6±9.4)分,均低于后前螺钉组的(80.9±11.0)分和(88.2±10.9)分,P<0.05。结论经皮由前向后置入拉力螺钉内固定治疗HaraguchiⅠ型后踝骨折的手术时间较短,但由后向前置入拉力螺钉的患者踝关节面复位情况和踝关节功能恢复情况均优于由前向后置入拉力螺钉的患者,且安全性更好。Objective To compare the efficacy of different methods of lag screw internal fixation for Haraguchi type Ⅰ posterior ankle fracture.Methods The clinical data of 80 patients with Haraguchi Type Ⅰ posterior ankle fracture who were treated in our hospital from Jan.2014 to Jan.2019 were retrospectively analyzed.There were 36males and 44 females,with an age of 55.9(43-67) years;the causes of injury showed sprain in 40 cases,road traffic injury in 31 cases and falling injury in 9 cases.Forty-two cases were treated by percutaneous anterior-posterior lag screw fixation (anterior and posterior screw group),and 38 cases were directly placed with lag screw via posterolateral approach (posterior and anterior screw group).The operation time,fracture healing time and time required for full weight bearing were compared between the two groups.The Burrwell-Charnley radiological score of ankle was used to compare the reduction of ankle joint surface between the two groups.The American Association of Foot and Ankle Surgery (AOFAS) score was used to evaluate the ankle joint function of the two groups at 6 and 12 months after operation,and postoperative complications of two groups were compared.Results The operative time in the anterior-posterior screw group[(50.4±9.6) minutes]was shorter than that in the posterior-anterior screw group[(68.5±12.8) minutes],and the difference was statistically significant(P<0.05).There was no statistically significant difference in the time required for complete weight bearing[(13.1±1.4) weeksvs.(12.6±1.3) weeks]and fracture healing time[(12.5±1.6) weeksvs.(11.8±1.6) weeks]between the two groups(P>0.05).The excellent BurrwellCharnley radiological score in the anterior-posterior screw group was 76.2%,which was lower than 89.5%in the posterior-anterior screw group,and the difference was statistically significant(P<0.05).At 6 and 12 months after surgery,the AOFAS scores of the anterior-posterior screw group were (75.4±13.1) points and (80.6±9.4) points,respectively,which were lower than those

关 键 词：后踝骨折 HaraguchiⅠ型 拉力螺钉 内固定 

分 类 号：R683.42[医药卫生—骨科学]