两种术前处理方案对Denis-Weber C型踝关节骨折患者术后踝关节功能及行走能力的影响  

Effects of two preoperative treatment schemes on postoperative ankle function and walking ability in patients with Denis-Weber type C ankle fracture

作　　者：薛刚 段永宏 孙鹏霄 XUE Gang;DUAN Yong-hong;SUN Peng-xiao(The First Department of Joint,Xi'an International Medical Center Hospital,Xi'an 710100,Shaanxi,CHINA)

机构地区：[1]西安国际医学中心医院关节一科,陕西西安710100

出　　处：《海南医学》2023年第23期3401-3405,共5页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:2022SF-491)。

摘　　要：目的探讨跟骨牵引治疗和石膏外固定的术前处理方案对Denis-Weber C型踝关节骨折患者术后踝关节功能及行走能力的影响。方法回顾性分析2021年5月至2022年5月西安国际医学中心医院收治的98例踝关节骨折患者的临床资料,根据患者术前处理方式的不同分组,其中48例术前采用跟骨牵引治疗患者纳入牵引组50例术前采用石膏外固定治疗者纳入外固定组。比较两组患者治疗后的临床效果,以及治疗前后的踝关节功能采用美国足踝关节协会踝与后足功能评分(AHS)评估和行走能力采用膝关节Lysholm功能评分评估。结果牵引组患者的治疗总有效率为89.58%,明显高于外固定组的74.00%,差异有统计学意义(P<0.05);牵引组患者的住院时间、骨性愈合时间、下床活动时间和负重行走时间分别为(9.32±1.47)d、(96.35±9.51)d、(5.35±1.27)d和(123.34±19.25)d,明显短于外固定组的(12.56±2.66)d、(123.21±16.42)d、(7.89±2.31)d和(154.44±24.26)d,差异均有统计学意义(P<0.05);术后6个月,牵引组患者的AHS量表总分为(88.13±8.26)分,明显高于外固定组的(71.32±6.25)分,差异有统计学意义(P<0.05);术后3个月和6个月,牵引组患者的Lysholm量表评分分别为(56.56±6.44)分和(75.26±8.65)分,明显高于外固定组的(51.23±6.31)分和(71.01±8.17)分,差异均有统计学意义(P<0.05);牵引组患者血管损伤发生率为12.50%,明显高于外固定组的2.00%,牵引组患者的感染坏死发生率为2.08%,明显低于外固定组的14.00%,差异均有统计学意义(P<0.05)。结论Denis-Weber C型踝关节骨折患者采用跟骨牵引治疗术前处理对其具有较好的临床疗效,患者术后踝关节功能和行走能力恢复情况更好,且可以降低感染坏死发生率,但术后血管损伤率较高。Objective To explore the effects of two preoperative treatment schemes(calcaneal traction and plaster external fixation)on postoperative ankle function and walking ability in patients with Denis-Weber type C ankle fracture.Methods The clinical data of 98 patients with ankle fractures in Xi'an International Medical Center Hospital between May 2021 and May 2022 were retrospectively analyzed.According to different preoperative treatment schemes,they were divided into traction group(48 cases,calcaneal traction)and external fixation group(50 cases,plaster external fixation).The clinical curative effect after treatment,ankle function[American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Scale(AHS)]and walking ability(Lysholm knee function scale)before and after treatment were compared between the two groups.Results The total response rate in the traction group was 89.58%,which was significantly higher than 74.00%in the external fixation group(P<0.05).The length of hospital stay,bone healing time,off-bed activity time,and weight-bearing walking time in the traction group were(9.32±1.47)d,(96.35±9.51)d,(5.35±1.27)d,and(123.34±19.25)d,which were significantly shorter than(12.56±2.66)d,(123.21±16.42)d,(7.89±2.31)d,(154.44±24.26)d in the external fixation group(P<0.05).At 6 months after surgery,total score of AHS in the traction group was(88.13±8.26)points,which was significantly higher than(71.32±6.25)points in the external fixation group(P<0.05).At 3 and 6 months after surgery,Lysholm scores in the traction group were(56.56±6.44)points and(75.26±8.65)points,which were significantly higher than(51.23±6.31)points,(71.01±8.17)points in the external fixation group(P<0.05).The incidence of vascular injury in the traction group was 12.50%,which was significantly higher than 2.00%in the external fixation group(P<0.05).The incidence of infection and necrosis in the traction group was 2.08%,which was significantly lower than 14.00%in the external fixation group(P<0.05).Conclusion The preoperative treatment o

关 键 词：跟骨牵引 石膏外固定 踝关节骨折 踝关节功能 行走能力 

分 类 号：R683.42[医药卫生—骨科学]