拉力钉与支撑钢板固定Haraguchi Ⅰ型后踝骨折比较  

Posterior-anterior lag screw versus buttress plate for fixation of Haraguchi type I posterior malleolus fractures

作　　者：许宏斌 杨学锋 蒋宜伟 徐克武 强胜林 贾永龙 黄凯 陈海 张德胤 XU Hongbin;YANG Xue-feng;JIANG Yi-wei;XU Ke-wu;QIANG Sheng-lin;JIA Yong-long;HUANG Kai;CHEN Hai;ZHANG De-yin(Departmentof Orthopaedics,Affiliated Hospital,Gansu University of Traditional Chinese Medicine,Lanzhou 730020,China)

机构地区：[1]甘肃中医药大学附属医院骨科,甘肃兰州730020

出　　处：《中国矫形外科杂志》2024年第19期1758-1763,共6页Orthopedic Journal of China

基　　金：甘肃省自然科学基金项目(编号:22JR5RA612)。

摘　　要：[目的]比较后前拉力螺钉与支撑钢板治疗Haraguchi Ⅰ 型后踝骨折的临床效果。[方法]回顾性分析2020年6月—2022年9月开放复位内定治疗Haraguchi Ⅰ 型后踝骨折80例患者的临床资料。根据医患沟通结果,38例采用后前拉力螺钉固定后踝(螺钉组),另外42例采用支撑钢固定后踝(钢板组),同时间处理合并的外踝和内踝骨折。比较两组围术期、随访及影像学资料。[结果]螺钉组在手术时间[(69.5±4.6) min vs (90.2±6.4) min, P<0.001]、切口总长度[(9.0±2.3) cm vs (10.3±2.6) cm, P=0.021]、术中失血量[(104.8±20.5) ml vs (116.0±21.3) ml, P=0.019]均显著少于钢板组,但螺钉组下地行走时间[(64.8±3.7) d vs(60.0±4.0) d, P=0.019]显著晚于钢板组,两组完全负重活动时间的差异无统计学意义(P>0.05)。与术后3个月相比,末次随访时,两组VAS、AOFAS评分及背伸-跖屈ROM均显著改善(P<0.05)。术后3个月,螺钉组AOFAS评分[(83.6±4.9) vs (86.0±5.5), P=0.044]显著低于钢板组,两组VAS评分及踝背伸-跖屈ROM的差异均无统计学意义(P>0.05);末次随访时,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、骨折愈合时间比较的差异均无统计学意义(P>0.05)。[结论]后前拉力螺钉与支撑钢板治疗Haraguchi Ⅰ 型后踝骨折的复位质量、功能改善相当,后者相对手术时间长、术中出血量多,但其下地行走时间早。[Objective]To compare the clinical outcomes of posterior-anterior lag screw versus buttress plate for fixation of Haraguchitype I posterior malleolus fractures.[Methods]A retrospective analysis was performed on 80 patients who received open reduction and in-ternal fixation(ORIF)for Haraguchi type I posterior malleolus fractures from June 2020 to September 2022.According to the doctor-pa-tient communication,38 case had the posterior malleolus fractures fixed with the posterior-anterior lag screw(the screw group),while other42 cases were fixed with buttress plate(the plate group),with the combined lateral and medial malleolar fractures treated simultaneously.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The screw group was significantly less than theplate group in terms of operative time[(69.5±4.6)min vs(90.2±6.4)min,P<0.001],total incision length[(9.0±2.3)cm vs(10.3±2.6)cm,P=0.021]and intraoperative blood loss[(104.8±20.5)ml vs(116.0±21.3)ml,P=0.019],although the former resumed postoperative walking sig-nificantly later than the latter[(64.8±3.7)days vs(60.0±4.0)days,P=0.019].There was no statistically significant difference in time to re-gain the full weight-bearing activity between the two groups(P>0.05).Compared with those 3 months after surgery,the VAS,AOFASscores and dorsal-plantar flexion ROM in both groups were significantly improved at the last follow-up(P<0.05).The screw group got sig-nificantly lower AOFAS score than the plate group 3 months after surgery[(83.6±4.9)vs(86.0±5.5),P=0.044],whereas there were no signifi-cant differences in VAS score and ankle-dorsal-plantar flexion ROM between the two groups(P>0.05).At the last follow-up,there was nosignificant difference between the two groups in terms of any items abovementioned(P>0.05).As for imaging,there were no significant dif-ferences in the quality of fracture reduction and healing time between the two groups(P>0.05).[Conclusion]Both posterior-anterior lagscrew and buttress plate achieve comparable cl

关 键 词：HaraguchiⅠ型后踝骨折 后前拉力螺钉 支撑钢板 临床疗效 

分 类 号：R683.42[医药卫生—骨科学]