根据损伤应力顺序制定手术方案在Lange-Hansen分型为旋前外旋型Ⅲ、Ⅳ度踝关节骨折病人的应用  

The application of operation plan based on injury stress sequence in the treatment of degree Ⅲ and Ⅳ ankle fractures with Lange-Hansen classification of pronation and external rotation

作　　者：方兵[1] 程杰 胡光峰 章鑫 李要争 任伟 FANG Bing;CHENG Jie;HU Guangfeng;ZHANG Xin;LI Yaozheng;REN Wei(Department of Orthopedics,Huangshan Shoukang Hospital,Huangshan,Anhui 245000,China)

机构地区：[1]黄山首康医院骨科,安徽黄山245000

出　　处：《临床外科杂志》2025年第2期166-170,共5页Journal of Clinical Surgery

摘　　要：目的 探讨根据损伤应力顺序制定手术方案在Lange-Hansen分型为旋前外旋型Ⅲ、Ⅳ度踝关节骨折病人的应用效果。方法 前瞻性选取2019年5月~2022年5月收治的踝关节骨折病人80例,均经过影像学检查为Lange-Hansen分型中旋前外旋型Ⅲ、Ⅳ度,采用随机数字表将病人分两组,研究组40例,采用按损伤应力顺序实施手术复位治疗,对照组40例,采用传统的复位顺序实施手术复位治疗方案。比较两组病人的手术时间、术中出血量、骨折愈合时间、完全负重时间、术前及术后1~6个月的踝关节背伸角、跖屈角、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝与后足功能评分、并发症。结果 研究组和对照组病人的手术时间分别为(44.80±5.12)分钟和(47.61±6.42)分钟,术中出血量分别为(43.81±9.02)ml和(51.50±12.01)ml,两组比较差异有统计学意义(P<0.05)。两组术前踝关节背伸角、跖屈角、AOFAS踝与后足功能评分比较差异无统计学意义(P>0.05)。研究组和对照组术后3个月踝关节的背伸角度分别为(16.84±1.77)°和(15.50±1.65)°,术后3个月的跖屈角度分别为(45.64±4.10)°和(42.58±3.86)°,术后6个月的跖屈角分别为(52.38±3.03)°和(50.64±3.74)°,术后3个月的最大步行距离评分分别为(3.50±0.64)分和(3.16±0.60)分,地面步行评分分别为(2.06±0.56)分和(1.72±0.48)分,踝关节前后活动评分分别为(4.96±1.38)分和(4.16±1.07)分,两组比较差异有统计学意义(P<0.05)。两组骨折愈合时间、完全负重时间、术后的疼痛评分、踝关节功能自主活动支撑评分、异常步态评分、术后6个月的最大步行距离评分、地面步行评分、踝关节前后活动评分、手术并发症比较差异均无统计学意义(P>0.05)。结论 根据损伤应力顺序实施手术复位治疗Lange-Hansen分型中旋前外旋型Ⅲ、Ⅳ度踝关节骨折有利于缩短手术时间,促进关节功能早期恢复。Objective To investigate the application of operation plan based on injury stress sequence in the treatment of degreeⅢandⅣankle fractures with Lange-Hansen classification of pronation and external rotation.Methods From May 2019 to May 2022,80 eligible patients of degreeⅢandⅣankle fractures with Lange-Hansen classification were selected prospectively and randomely divided into 2 groups:40 patients in the study group were treated with surgical reduction according to the sequence of injury stress,and the other 40 patients in the control group were treated with traditional reduction sequence.The operative time,intraoperative blood loss,fracture healing time,full weight-bearing time,Ankle dorsoextension Angle,plantar flexion Angle,and American Orthopaedic Foot and Ankle Association were compared between the two groups Society,(AOFAS)Ankle and posterior foot function scores and complications.Results The surgical time[(44.80±5.12)min vs.(47.61±6.42)min]and surgical bleeding volume[(43.81±9.02)ml vs.(51.50±12.01)ml]between the study group and the control group were statistically significant(all P<0.05).Before surgery,there had no significant differences in ankle joint dorsiflexion angle,plantar flexion angle,AOFAS ankle and hind foot function score in 2 groups(all P>0.05).The ankle dorsiflexion angle at 3 months after surgery[(16.84±1.77)°vs.(15.50±1.65)°],plantar flexion angle at 3 months after surgery[(45.64±4.10)°vs.(42.58±3.86)°]and at 6 months after surgery[(52.38±3.03)°vs.(50.64±3.74)°],the maximum walking distance score[(3.50±0.64)vs.(3.16±0.60)],ground walking score[(2.06±0.56)vs.(1.72±0.48)]and ankle joint anteroposterior activity score at 3 months after surgery[(4.96±1.38)vs.(4.16±1.07)]of the study group were all higher than those in the control group(all P<0.05).There was no statistically significant difference in terms of fracture healing time,complete weight-bearing time,postoperative pain score,ankle joint function autonomous activity support score,abnormal gait score,maximum

关 键 词：损伤应力顺序 切开复位内固定 Lange-Hansen分型 旋前外旋型 踝关节骨折 

分 类 号：R68[医药卫生—骨科学]