青少年创伤性踝内翻截骨矫正两种固定比较  

Internal fixation versus external counterpart in supramalleolar osteotomy for correction of traumatic ankle varus deformity in adolescents

作　　者：赵博[1] 王雪[1] 王成伟 海几哲[3] 阿依丁·夏哈太 陀亚楠 艾科热木·吾普尔 帕尔哈提·瓦哈甫[1] ZHAO Bo;WANG Xue;WANG Cheng-wei;HAI Ji-zhe;Ayidin Shahatai;TUO Ya-nan;Akeremu Wupur;Parhati Wa-hafu(The Sixth Affiliated Hospital,Xinjiang Medical University,Urumqi 830002,China;Affiliated Cancer Hospital,Xinjiang Medical University,Urumqi 830000,China;Xinjiang University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第六附属医院,新疆乌鲁木齐830002 [2]新疆医科大学附属肿瘤医院,新疆乌鲁木齐830000 [3]新疆大学,新疆乌鲁木齐830000

出　　处：《中国矫形外科杂志》2024年第7期577-583,共7页Orthopedic Journal of China

基　　金：国家自然科学基金地区科学基金项目(编号:52165026)。

摘　　要：[目的]比较踝上截骨(supramalleolar osteotomy,SMOT)钢板内固定与SMOT联合Ilizarov架牵伸治疗青少年创伤性踝关节内翻畸形(traumatic ankle joint varus deformity,TAVD)临床疗效。[方法]回顾性分析2015年2月—2022年2月在本院治疗的30例青少年TAVD患者的临床资料。根据医患沟通结果,16例采用SMOT解剖钢板内固定治疗(内固定组),14例采用SMOT联合Ilizarov外固定治疗(外固定组)。比较两组围手术期、随访与影像资料。[结果]内固定组在手术时间[(90.0±11.6)min vs(102.1±9.1)min,P=0.004]、住院时间[(13.3±4.4)d vs(18.5±5.3)d,P=0.007]显著优于外固定组,但前者在术中失血量[(156.9±46.7)ml vs(90.7±14.4)ml,P<0.001]、切口总长度[(14.5±2.3)cm vs(4.6±0.8)cm,P<0.001]、下地行走时间[(71.7±16.7)d vs(5.6±2.3)d,P<0.001]显著不及后者。随访时间平均(20.6±3.5)个月,术后随时间推移两组VAS、AOFAS评分显著改善(P<0.05)。术后6个月,内固定组VAS评分显著优于外固定组[(1.3±1.3)vs(2.6±1.6),P=0.023]。影像方面,与术前相比,术后两组TT、TAS角及Takakura分期均显著改善(P<0.05)。术后3个月,内固定组TAS角[(89.8±1.4)°vs(87.6±3.4)°,P=0.036]及Takakura分期[0/I/II/IIIa/IIIb/IV,(2/11/3/0/0/0)vs(0/7/6/1/0/0),P=0.038]显著优于外固定组(P<0.05)。[结论]两种手术固定方式均能有效治疗青少年TAVD。与内固定相比,外固定组具有手术创伤小、出血少、早期负重活动、避免植骨等优势,但存在手术时间长、住院时间长、术中透视多,患者痛苦大等缺点。[Objective]To compare clinical efficacy of supramalleolar osteotomy(SMOT)with plate internal fixation(IF)versus external fixation(EF)by distracting Ilizarov frame for traumatic ankle varus deformity(TAVD)in adolescents.[Methods]A retrospective analysis was performed on 30 adolescent patients with TAVD treated in our hospital from February 2015 to February 2022.According to doctor-pa⁃tient communication,16 patients had SMOT with IF of anatomical plate,while other 14 patients were treated with SMOT with EF of distract⁃ing Ilizarov frame.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The IF group proved signifi⁃cantly superior to the EF group in terms of operation time[(90.0±11.6)min vs(102.1±9.1)min,P=0.004]and hospital stay[(13.3±4.4)days vs(18.5±5.3)days,P=0.007],whereas significantly inferior to the EF group in terms of intraoperative blood loss[(156.9±46.7)ml vs(90.7±14.4)ml,P<0.001],total incision length[(14.5±2.3)cm vs(4.6±0.8)cm,P<0.001],and postoperative ambulation time[(71.7±16.7)days vs(5.6±2.3)days,P<0.001].The mean follow-up period lasted for(20.6±3.5)months on an average,and the VAS and AOFAS scores in both groups were significantly improved over time(P<0.05).Morever,the IF proved significantly better than the EF group regarding VAS score 6 months postoperatively[(1.3±1.3)vs(2.6±1.6),P=0.023].Regarding image,talus title(TT),tibial anterior surface angle(TAS),and Takakura scale were significantly improved in both groups after surgery compared with those preoperatively(P<0.05).The IF group was significantly superior to the EF group in terms of TAS[(89.8±1.4)°vs(87.6±3.4)°,P=0.036]and Takakura grade[0/I/II/IIIa/IIIb/IV,(2/11/3/0/0/0)vs(0/7/6/1/0/0),P=0.038]3 months after surgery.[Conclusion]Both fixation methods in SMOT are effective in the treatment of juvenile TAVD.Compared with internal fixation,the external fixation has advantages of less surgical trauma,less bleeding,early weight-bearing activities,avoiding bone grafting,etc.,whereas it ha

关 键 词：青少年 创伤性踝内翻 踝上截骨 内固定 外固定 

分 类 号：R687[医药卫生—骨科学]