切开复位内固定术治疗旋后外旋型踝关节骨折的效果分析  

Efficacy of cut-and-replace internal fixation in the treatment of postrotation external rotation ankle fractures and its effect on patients'joint function and mobility

作　　者：刘亮 周恩瑜 邬玉林 唐玉坤 四朗多吉 曾雪忠 喻杉[2] Liu Liang;Zhou Enyu;Wu Yulin;Tang Yukun;Si Langduoji;Zeng Xuezhong;Yu Shan(Department of Orthopedics,Ganzi Tibetan Autonomous Prefecture People's Hospital,Kangding 626000,China;Department of Orthopaedics,Sichuan Orthopaedic Hospital,Chengdu 610041,China)

机构地区：[1]甘孜藏族自治州人民医院骨科,康定626000 [2]四川省骨科医院骨科,成都610041

出　　处：《中国综合临床》2024年第5期321-327,共7页Clinical Medicine of China

基　　金：四川省医学会科研课题(2021TG42)

摘　　要：目的探讨切开复位内固定术(open reduction and internal fixation,ORIF)对旋后外旋型(supination-external rotation,SER)踝关节骨折(ankle fractures,AF)患者的治疗效果。方法选取2020年1月至2023年4月于甘孜藏族自治州人民医院就诊的155例SER-AF患者的临床资料,按照倾向性评分匹配分为观察组与对照组,每组各74例。观察组患者给予ORIF进行治疗,对照组患者给予手法复位联合石膏外固定法进行治疗,两组患者均于治疗3、6个月后进行回访,比较两组患者治疗前及治疗3、6个月后踝关节功能水平[Kofoed评分、AOFAS评分、Olerud-Molander踝关节主观评分(Olerud Molander ankle score,OMAS)],比较两组患者治疗6个月后临床指标及不良事件发生情况。呈正态分布的计量资料组间比较采用t检验;多组间比较采用方差分析,两两比较采用Dunnett-t检验。计数资料组间比较采用χ2检验或Fisher确切概率法。结果治疗前,两组患者Kofoed评分、AOFAS评分、OMAS比较差异均无统计学意义(均P>0.05);观察组患者治疗前及治疗3、6个月Kofoed评分分别为(53.78±6.40)、(76.73±4.12)、(89.07±5.78)分,对照组分别为(52.22±7.08)、(71.68±4.82)、(84.05±5.45)分,两组患者治疗3、6个月Kofoed评分均高于治疗前(均P<0.05),且观察组均高于对照组(均P<0.01)。观察组患者治疗前及治疗3、6个月AOFAS评分分别为(70.13±5.39)、(81.62±4.25)、(92.05±4.15)分,对照组分别为(69.85±5.41)、(79.08±4.60)、(88.92±4.43)分,两组患者治疗3、6个月AOFAS评分均高于治疗前(均P<0.05),且观察组高于对照组(均P<0.01)。观察组患者治疗前及治疗3、6个月OMAS分别为(53.43±5.07)、(76.14±4.52)、(85.68±4.14)分,对照组分别为(54.42±4.86)、(71.39±3.94)、(81.78±4.15)分,两组患者治疗3、6个月OMAS评分均高于治疗前(均P<0.05),且观察组均高于对照组(均P<0.01)。观察组患者骨折愈合时间(38.85±4.50)d、完全负重时间(66.62±7.14)d均短于To investigate the therapeutic effect of open reduction and internal fixation(ORIF)on supination external rotation(SER)ankle fractures(AF)and its impact on ankle joint function and range of motion in patients.MethodsThe observation group patients were treated with ORIF,while the control group patients were treated with manual reduction combined with plaster external fixation.Both groups of patients were followed up after 3 and 6 months of treatment.Compare the ankle joint function levels of two groups of patients before treatment and after 3 and 6 months of treatment(Kofood score,AOFAS score,Olerud Molander subjective ankle score(OMAS)).Compare the joint range of motion(relative peak force,torque acceleration energy,endurance)between two groups of patients after 3 and 6 months of treatment.Compare the clinical indicators and incidence of adverse events between two groups of patients after 6 months of treatment.T-test was used for comparison between two groups.Multiple group comparisons were conducted using analysis of variance,while pairwise comparisons were conducted using Dunnett-t test.Comparison of count data between groups usingχ^(2)inspections or Fisher exact test.ResultsBefore treatment,there was no statistically significant difference in the Kofoed score,AOFAS score,and OMAS score between the two groups of patients(all P>0.05).The Kofoed scores of patients in the observation group before treatment and at 3 and 6 months of treatment were(53.78±6.40),(76.73±4.12),and(89.07±5.78)points,respectively.The control group was(52.22±7.08),(71.68±4.82),and(84.05±5.45)points,respectively.The Kofoed scores of patients in both groups were higher than before treatment at 3 and 6 months of treatment(all P<0.05),and the observation group was higher than the control group(all P<0.01).The AOFAS scores of patients in the observation group before treatment and at 3 and 6 months of treatment were(70.13±5.39),(81.62±4.25),and(92.05±4.15)points,respectively.The control group was(69.85±5.41),(79.08±4.60),and(88.92±4.

关 键 词：踝关节骨折 旋后外旋型 切开复位内固定术 踝关节功能 

分 类 号：R687.4[医药卫生—骨科学]