腓骨髓内钉和切开复位腓骨钢板固定治疗中青年不稳定型踝关节骨折的对比研究  

Fibular nailing versus open reduction plate fixation for unstable ankle fractures in the young

作　　者：熊远飞 刘晖[1] 张剑平 徐维臻 张金辉 吴进[1] Xiong Yuanfei;Liu Hui;Zhang Jianping;Xu Weizhen;Zhang Jinhui;Wu Jin(Department of Orthopaedics,No.909 Hospital of PLA&Dongnan Hospital Affiliated to Xiamen University,Zhangzhou,Fujian Province 363000,China)

机构地区：[1]解放军第909医院暨厦门大学附属东南医院骨科,福建漳州363000

出　　处：《创伤外科杂志》2024年第12期918-923,共6页Journal of Traumatic Surgery

基　　金：全军后勤科研项目(20XLS21)。

摘　　要：目的探讨腓骨髓内钉和切开复位腓骨钢板固定治疗中青年不稳定型踝关节骨折的临床疗效。方法前瞻性研究2022年1月—2022年12月厦门大学附属东南医院骨科收治的52例中青年不稳定型踝关节骨折患者临床资料,男性30例,女性22例;年龄18~60岁,平均49.1岁。随机分为腓骨髓内钉组(26例)与切开复位钢板组(26例),比较两组术前等待时间、手术时间、术中透视次数、骨折愈合时间、踝关节功能及并发症等指标。结果两组患者的性别比例、年龄、BMI、致伤原因、骨折分型等一般资料比较差异无统计学意义(P均>0.05)。腓骨髓内钉组术前等待时间(4.7±1.7)d显著少于切开复位钢板组(7.6±1.9)d,差异有统计学意义(P=0.008);腓骨髓内钉组的平均手术透视次数(7.9±1.4)次多于切开复位钢板组(4.8±1.2)次,差异有统计学意义(P<0.001)。患者均获10~20个月的随访,两组患者手术时间[(81.4±7.6)min vs.(75.5±6.3)min]、骨折愈合时间[(4.4±1.0)个月vs.(4.1±1.0)个月]、末次随访时AOFAS踝-后足评分[(84.8±16.3)分vs.(82.1±19.4)分]等指标比较差异无统计学意义(P均>0.05)。切开复位钢板组术后总体并发症发生率(5例,19.2%)和切口并发症发生率(4例,15.4%)均高于腓骨髓内钉组(3例,11.5%和1例,3.8%),但差异无统计学意义(P=0.223和P=0.158)。切开复位钢板组术后12例(46.2%)取出内固定,明显多于腓骨髓内钉组的6例(23.1%),P=0.048。结论腓骨髓内钉与切开复位腓骨钢板固定均是治疗中青年不稳定型踝关节骨折患者安全有效的方法,前者并发症更少,但术中透视次数更多。Objective To compare the clinical efficacy of fibularnailing vs.open reduction fibular plate fixation in the treatment of unstable ankle fractures in young patients.Methods A prospective analysis was conducted on clinical data of 52 young patients with unstable ankle fractures admitted to ourhospital from Jan.2022 to Dec.2022,including 30 males and 22 females aged 18-60(mean 49.1)years.Patients were randomly divided into fibularnailing group and open reduction plate fixation(OrPF)group(n=26 for each).The preoperative waiting time,operation time,numberof intraoperative fluoroscopies,time to bone union,ankle function,and complications of the two groups were recorded and compared.Results There was no significant difference in general infor mation between the two groups,including gender,age,BMI,injury causes and fracture classifications(all P>0.05).Compared with the OrPF group,the fibularnailing group revealed a much shorterpreoperative waiting time(d,4.7±1.7 vs.7.6±1.9,P=0.008)and similaroperation time(min,81.4±7.6 vs.75.5±6.3,P=0.104),but much more frequent intraoperative fluoroscopy(7.9±1.4 vs.4.8±1.2,P<0.001).All patients were followed up for 10-20 months,which showed no significant difference in terms of time to bone union(months,4.4±1.0 and 4.1±1.0)and AOFAS ankle-hindfoot score at the last follow-up(84.8±16.3 vs.82.1±19.4)between the two groups(both P>0.05).In addition,the fibularnailing group had fewercases with postoperative complications(3 vs.5,P=0.223)and incision-related complications(1 vs.4,P=0.158),but the difference was insignificant compared with the OrPF group.The internal fixators were removed in 6 cases(23.1%)in the fibularnailing group,significantly fewerthan the 12 cases(46.2%)in the OrPF group(P=0.048).Conclusion Both fibularnailing and OrPF are effective and safe methods for treating unstable ankle fractures in young patients,and the for mershowed fewercomplications but more frequent intraoperative fluoroscopy.

关 键 词：不稳定型踝关节骨折 腓骨髓内钉 切开复位内固定 功能评分 并发症 

分 类 号：R683.42[医药卫生—骨科学]