空心钉与支撑钢板固定后踝骨折块的比较  

Cannulated screws versus support plate for fixation of posterior malleolus fracture fragment

作　　者：魏建军[1] 颜世昌[1] 杨永江[1] 杨丰真[1] 田纪伟[1] WEI Jian-jun;YAN Shi-chang;YANG Yong-jiang;YANG Feng-zhen;TIAN Ji-wei(Department of Orthopaedic,BenQ Hospital,Nanjing Medical University,Nanjing,210019,China)

机构地区：[1]南京医科大学附属明基医院骨科,江苏南京210019

出　　处：《中国矫形外科杂志》2024年第8期691-696,共6页Orthopedic Journal of China

摘　　要：[目的]比较空心钉固定和支撑钢板固定三踝骨折和后踝骨折块的临床疗效。[方法]回顾性分析2018年2月-2021年2月68例三踝骨折患者的临床资料。根据医患沟通结果,41例采用空心钉固定后踝骨块,另外27例采用支撑钢板固定。比较两组围手术期指标、随访及影像资料。[结果]两组手术时间、切口长度、术中出血量、术中透视次数、切口愈合等级、住院时间、下地行走时间、切口感染、血管栓塞事件的差异均无统计学意义(P>0.05)。空心钉组的趾屈曲挛缩[例(%), 2 (4.9)vs 7 (25.9), P=0.012]及内置物激惹[例(%), 3 (7.3) vs 11 (40.7), P<0.001]的发生率显著优于支撑板组。与术后3个月相比,末次随访时,两组VAS评分、AOFAS评分及踝背伸/跖屈ROM均显著改善(P<0.05)。相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量、骨愈合、创伤性关节炎发生情况的差异均无统计学意义(P>0.05)。与术前相比,末次随访时,两组TFCS、MCS均显著减小(P<0.05),相应时间点,两组间TFCS、MCS的差异均无统计学意义(P>0.05)。[结论]空心钉和支撑钢板均可有效固定后踝骨折块,获得满意的踝关节功能,但需随访创伤后关节炎的进展。与支撑钢板固定相比,空心钉固定操作更简单有效,内置物相关并发症更少。[Objective] To compare the clinical efficacy of cannulated screw fixation versus support plate fixation of the posterior malleolar fracture fragment in the trimalleolar fractures. [Methods] A retrospective study was done on 68 patients who received surgical treatment for trimalleolar fractures from February 2018 to February 2021. According to the surgeon-patient communication, 41 patients had the posterior malleolus fragment fixed with cannulated screws(CS), while the other 27 patients were fixed with support plates(SP). The data regarding to perioperative period, follow-up and images were compared between the two groups. [Results] There were no significant differences in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, incision healing grade, hospital stay, walking time, occurrences of incision infection and thrombosis events between the two groups(P>0.05). However, the CS group proved significantly superior to the SP group in terms of incidence of toe flexion contracture [case(%), 2(4.9) vs 7(25.9), P=0.012] and implant irritation [case(%), 3(7.3) vs 11(40.7), P<0.001]. Compared with those 3 months after surgery, the VAS score, AOFAS score and ankle-dorsiflexion/plantar flexion ROM in both groups were significantly improved at the last follow-up(P<0.05), whereas which were not statistically significant at any corresponding time points between the two groups(P>0.05). Radiographically, there were no statistically significant differences in the quality of fracture reduction, bone healing and traumatic arthritis between the two groups(P>0.05). The tibiofibular clear space(TFCS) and medial clear space(MCS) in both groups were significantly decreased at the last follow-up compared with those preoperatively(P>0.05), while there were no significant differences in TFCS and MCS between the two groups at corresponding time points(P>0.05).[Conclusion] Both cannulated screws and support plates do effectively fix posterior malleolus fracture, and achieve satisfactory clin

关 键 词：三踝骨折 后踝骨折 开放复位内固定 空心钉 钢板 

分 类 号：R683.42[医药卫生—骨科学]