踝关节镜联合闭合复位导向器与切开复位治疗三踝骨折的疗效比较  

Clinical efficacy comparison of ankle arthroscopy combined with closed reduction guide and open reduction in the treatment of trimalleolar fracture

作　　者：李基新 王磊[1] 张宇航 魏增伯 杨建磊[1] 刘有军[1] 于同军 LI Jixin;WANG Lei;ZHANG Yuhang;WEI Zengbo;YANG Jianlei;LIU Youjun;YU Tongjun(Department of Orthopedics,Tianjin Beichen Hospital,Tianjin 300400,China)

机构地区：[1]天津市北辰医院骨科,300400

出　　处：《天津医药》2024年第11期1197-1201,共5页Tianjin Medical Journal

基　　金：天津市北辰区科技计划项目(SHGY-2020011)。

摘　　要：目的比较踝关节镜联合闭合复位导向器与常规手术切开治疗三踝骨折的临床疗效。方法纳入60例三踝骨折患者并根据其接受的手术方式分为踝关节镜联合闭合复位导向器手术组(关节镜组)和常规切开手术组(切开组),每组30例。观察并比较2组患者手术时间、术中出血量及并发症情况,采用美国足踝外科协会(AOFAS)踝与后足评分和伤残指数评分(FADI)评价患者的疼痛和功能恢复情况。结果与关节镜组比,切开组的手术时间延长,内踝侧切口长度减小,出血量减少,皮肤麻木比例下降(P<0.05)。关节镜组术后12个月AOFAS总分和FADI评分高于切开组(P<0.05)。关节镜组内无软骨损伤患者术后12个月AOFAS评分高于有软骨损伤患者(P<0.05),而有无软骨损伤的患者间疼痛及力线评分差异无统计学意义(P>0.05)。结论应用踝关节镜技术联合闭合复位导向器治疗三踝骨折能够使患者获得更好的术后疗效,但和切开术式相比,其在手术时间、切口感染方面无明显优势。Objective To compare the clinical efficacy of ankle arthroscopy combined with closed reduction guide and conventional surgical incision in the treatment of trimalleolar fracture.Methods A total of 60 patients with ankle fracture were divided into two groups according to different surgical plans:the ankle arthroscopy combined with closed reduction guide surgery group(arthroscopy group)and the conventional incision surgery group(incision group),with 30 cases in each group.The operative time,intraoperative blood loss and complications of the two groups were observed and compared.Pain and functional recovery of patients were evaluated by the American Orthopaedic Foot&Ankle Society(AOFAS)ankle and hind foot scores and Foot and Ankle Disability Index(FADI)scores.Results All 60 patients were followed up.Compared with the arthroscopy group,patients in the incision group had a longer surgical time,a shorter incision length in the medial malleolus,a reduced number of cases of skin numbness and reduced bleeding(P<0.05).The AOFAS score and the FADI score at 12 months after surgery were higher in the arthroscopic group than those of the incision group(P<0.05).After 12 months of surgery,the AOFAS score in patients without cartilage injury of the arthroscopic group were higher than those of patients with cartilage injury(P<0.05),while there were no significant differences in pain and force line scores between patients with cartilage injury and patients without cartilage injury(P>0.05).Conclusion The application of ankle arthroscopy combined with closed reduction guide in the treatment of trimalleolar fracture can achieve better postoperative results,but it has no obvious advantages in operation time and incision infection compared with the incision surgery.

关 键 词：踝骨折 关节镜检查 闭合复位导向器 软骨损伤 疗效评价 

分 类 号：R683.42[医药卫生—骨科学]