腓骨入路固定与腓骨后外侧入路固定治疗旋后外旋型踝关节骨折疗效比较  

Comparison of the therapeutic effects of fibular approach fixation and posterior lateral fibular approach fixation in the treatment of supine and outward rotation ankle fractures

作　　者：曹志[1] 汤立新[2] 王海宇 CAO Zhi;TANG Lixin;WANG Haiyu(Department of Orthopaedics,the Second Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan Province,China;Department of Orthopaedics,Nanyang Central Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳医学高等专科学校第二附属医院骨一科,河南南阳473000 [2]南阳市中心医院骨一科,河南南阳473000

出　　处：《新乡医学院学报》2025年第3期208-212,218,共6页Journal of Xinxiang Medical University

摘　　要：目的比较腓骨入路固定、腓骨后外侧入路固定治疗旋后外旋型踝关节骨折的疗效。方法选择2020年1月至2023年1月南阳医学高等专科学校第二附属医院收治的189例旋后外旋型踝关节骨折患者为研究对象,按照手术方法将患者分为腓骨入路组(n=95)和后外侧入路组(n=94);腓骨入路组患者行腓骨入路内固定治疗,后外侧入路组患者行腓骨后外侧入路固定治疗。比较2组患者的手术时间、术中出血量等手术指标。分别于治疗前及治疗后3、7 d抽取患者外周静脉血,应用酶联免疫吸附法测定患者疼痛应激指标P物质(SP)、神经肽Y(NPY)、前列腺素E_(2)(PGE_(2))水平,使用MAGLUMI 1000全自动化学发光分析仪检测氧化应激指标超氧化物歧化酶(SOD)、总抗氧化能力(TAC)、过氧化氢酶(CAT)水平。2组患者均随访6个月,使用Mazur评分评估患者入院未治疗前及治疗后1、3、6个月踝关节功能,根据患者治疗后6个月时Mazur评分评估临床疗效。统计住院时间及随访期间患者骨折未愈合、畸形愈合等不良事件发生情况。结果2组患者的手术时间及术中出血量比较差异无统计学意义(P>0.05)。后外侧入路组患者的住院时间显著短于腓骨入路组(P<0.05)。治疗前,2组患者的血清SP、NPY、PGE_(2)水平比较差异无统计学意义(P>0.05);2组患者治疗后3、7 d的血清SP、NPY、PGE_(2)水平显著高于治疗前,治疗后3 d的血清SP、NPY、PGE_(2)水平显著高于治疗后7 d(P<0.05);治疗后3、7 d,后外侧入路组患者的血清SP、NPY、PGE_(2)水平显著低于腓骨入路组(P<0.05)。治疗前,2组患者的血清SOD、TAC、CAT水平比较差异无统计学意义(P>0.05);治疗后3、7 d,2组患者的血清SOD、TAC、CAT水平显著高于治疗前,2组患者治疗后3 d的血清SOD、TAC、CAT水平显著高于治疗后7 d(P<0.05);治疗后3、7 d,后外侧入路组患者的血清SOD、TAC、CAT水平显著低于腓骨入路组(P<0.05)。治疗前,Objective To compare the therapeutic effects of fibular approach fixation and posterior lateral fibular approach fixation in the treatment of supine and outward rotation ankle fractures.Methods A total of 189 patients with supine and outward rotation ankle fractures admitted to the Second Affiliated Hospital of Nanyang Medical College from March 2020 to March 2023 were selected and then divided into a fibular approach group(n=95)and a posterior lateral approach group(n=94)according to the surgical method.Patients in the fibular approach group received fibular internal fixation treatment,while those in the posterior lateral approach group received posterior lateral fibular fixation treatment.Surgical indicators such as operation time and intraoperative blood loss were compared between the two groups.Peripheral venous blood samples were collected from patients before treatment,3 and 7 days after treatment.Enzyme linked immunosorbent assay was used to measure the levels of pain stress markers substance P(SP),neuropeptide Y(NPY),and prostaglandin E_(2)(PGE_(2)).An MAGLUMI 1000 automatic chemiluminescence analyzer was used to detect the levels of oxidative stress markers superoxide dismutase(SOD),total antioxidant capacity(TAC),and catalase(CAT).The patients in both groups were followed up for 6 months,and the Mazur score was used to evaluate ankle joint function before treatment and 1,3,and 6 months after treatment.The clinical efficacy was evaluated based on the Mazur score obtained 6 months after treatment.The occurrence of adverse events such as nonunion and malunion of fractures in patients during hospitalization and the follow-up period were recorded.Results There was no statistically significant difference in the operation time and intraoperative blood loss between the two groups(P>0.05).The hospitalization time of patients in the posterior lateral approach group was significantly shorter than that in the fibular approach group(P<0.05).Before treatment,there was no statistically significant difference in the le

关 键 词：腓骨入路固定 腓骨后外侧入路固定 旋后外旋型踝关节骨折 

分 类 号：R687.3[医药卫生—骨科学]