腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折的对比研究  

A comparative study of open reduction and internal fixation through fibular approach versus malleolar posterolateral approach for treatment of supination-extorsion-type gradeⅣankle fractures

作　　者：刘骏逸 刘晓东 李朝晖 LIU Junyi;LIU Xiaodong;LI Zhaohui(Luoyang Orthopedic-Traumatological Hospital,Zhengzhou 450016,Henan,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,河南郑州450016

出　　处：《中医正骨》2021年第9期15-19,24,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折的临床疗效及安全性。方法:回顾性分析2014年1月至2018年1月收治的122例踝关节旋后外旋型Ⅳ度骨折患者的病例资料,患者均采用切开复位内固定治疗,其中43例采用腓骨入路(腓骨入路组)、79例采用踝关节后外侧入路(后外侧入路组)。记录手术时间、术中出血量,采用Burwell-Charnley放射学复位标准评价术后1周CT检查的踝关节复位质量,采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价术后12个月的综合疗效,观察并发症发生情况。结果:2组患者手术时间、术中出血量及术后12个月的AOFAS踝与后足评分比较,组间差异均无统计学意义[(108.73±14.95)min,(111.75±11.67)min,t=1.279,P=0.763;(189.93±38.46)mL,(201.27±31.88)mL,t=1.593,P=0.126;(89.17±5.12)分,(91.31±4.77)分,t=0.768,P=0.313]。腓骨入路组的复位质量优40例、中3例,后外侧入路组的复位质量优61例、中18例,腓骨入路组的复位质量优于后外侧入路组(χ^(2)=4.883,P=0.027)。2组患者均未出现切口深层感染及骨折不愈合。腓骨入路组出现2例切口浅表感染、1例小腿肌间静脉血栓,后外侧入路组出现3例切口浅表感染、2例切口裂开、1例腓肠神经损伤、2例小腿肌间静脉血栓;2组患者并发症发生率比较,差异无统计学意义(χ^(2)=0.337,P=0.803)。结论:腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折,在手术时间、术中出血量、综合疗效及并发症发生率方面无明显差异,但采用腓骨入路可以获得更好的复位效果。Objective:To compare the clinical curative effects and safety of open reduction and internal fixation through fibular approach(FA)versus malleolar posterolateral approach(PLA)for treatment of supination-extorsion-type gradeⅣankle fractures.Methods:The medical records of 122 patients with supination-extorsion-type gradeⅣankle fractures recruited from January 2014 to January 2018 were analyzed retrospectively.Forty-three patients were treated with open reduction and internal fixation through FA(FA group)and 79 ones with open reduction and internal fixation through malleolar PLA(PLA group).The operative time and intraoperative blood loss were recorded and compared between the 2 groups.The ankle reduction outcome checked by CT at 1 week after the surgery was evaluated by using Burwell-Charnley radiological reduction criteria.The total curative effects was evaluated by using American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores at 12 months after the surgery,and the complications were observed.Results:There was no statistical difference in operative time,intraoperative blood loss and AOFAS ankle-hindfoot scores measured at 12 months after the surgery between the 2 groups(108.73±14.95 vs 111.75±11.67 minutes,t=1.279,P=0.763;189.93±38.46 vs 201.27±31.88 mL,t=1.593,P=0.126;89.17±5.12 vs 91.31±4.77 points,t=0.768,P=0.313).The ankle reduction outcome was evaluated according to Burwell-Charnley radiological reduction criteria,40 patients got an excellent result and 3 fair in FA group;while 61 patients obtained an excellent result and 18 fair in PLA group.The ankle reduction outcome was better in FA group compared to PLA group(χ^(2)=4.883,P=0.027).The complications such as deep incision infection and fracture nonunion were unfound in the 2 groups;whereas the superficial incision infection(2 cases)and intramuscular calf vein thrombosis(1 case)were found in FA group,and the superficial incision infection(3 cases),incision dehiscence(2 cases),sural nerve injuries(1 case)and intramuscular calf vein t

关 键 词：踝关节 骨折固定术 内 手术入路 临床试验 

分 类 号：R687.3[医药卫生—骨科学]