不同固定方案对三踝骨折患者术后近远期下肢功能的影响  

Effects of different fixation methods on the short- and long-term lower limb function in patients with trimalleolar fractures

作　　者：张立 刑润麟 梅伟 ZHANG Li;XING Run-lin;MEI Wei(Department of Orthopedics and Traumatology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院骨伤科,江苏南京210000

出　　处：《川北医学院学报》2025年第3期302-305,共4页Journal of North Sichuan Medical College

基　　金：江苏省医学重点学科·实验室建设单位项目(JSDW202252)。

摘　　要：目的:探讨不同固定方案对三踝骨折患者术后近远期下肢功能的影响。方法:回顾性分析84例三踝骨折患者的临床资料,根据其后踝骨折固定方案将患者分为钢板固定组(n=45)与空心螺钉固定组(n=39),比较两组患者手术指标(手术时间、术中出血量、术后住院时间)、术前与术后早期踝关节跖屈和背伸角度、疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分。所有患者术后随访12个月,比较其后踝愈合时间及术后6、12个月的AOFAS踝-后足评分。结果:钢板固定组手术时间长于空心螺钉固定组(P<0.05),两组术中出血量、术后住院时间差异均无统计学意义(P>0.05)。术后1个月,两组踝关节跖屈和背伸角度均增大(P<0.05),且钢板固定组大于空心螺钉固定组(P<0.05);两组疼痛VAS评分均降低(P<0.05),且钢板固定组低于空心螺钉固定组(P<0.05);两组AOFAS踝-后足评分均升高(P<0.05),且钢板固定组高于空心螺钉固定组(P<0.05)。两组术后近期治疗优良率无统计学差异(P>0.05)。两组后踝愈合时间及术后6、12个月AOFAS踝-后足评分无统计学差异(P>0.05)。结论:相对于空心螺钉固定,钢板固定更有利于三踝骨折患者术后早期踝关节功能恢复,两种固定方式对下肢功能的远期影响无显著差异。Objective:To explore the effects of different fixation methods on the short-and long-term lower limb function in patients with trimalleolar fractures.Methods:A retrospective analysis was conducted on clinical data from 84 patients with trimalleolar fractures patients were divided into two groups based on their posterior malleolus fracture fixation method:a plate fixation group(n=45) and a cannulated screw fixation group(n=39).Surgical indicators(operation time,intraoperative blood loss,postoperative hospital stay),preoperative and early postoperative ankle plantarflexion and dorsiflexion angles,Visual Analogue Scale(VAS) pain scores,and American Orthopaedic Foot & Ankle Society(AOFAS) Ankle-Hindfoot Scores were compared between the two groups.All patients underwent follow-up for 12 months after surgery to compare the time to posterior malleolus union and AOFAS Ankle-Hindfoot Scores at 6 and 12 months postoperatively.Results:The operation time was longer in the plate fixation group compared to the cannulated screw fixation group(P<0.05).There were no significant differences between the two groups in terms of intraoperative blood loss and postoperative hospital stay(P>0.05).1 month postoperatively,both groups showed increased ankle plantarflexion and dorsiflexion angles,with the plate fixation group having larger angles than the cannulated screw fixation group(P<0.05).At 1 month postoperatively,both groups had reduced pain Visual Analogue Scale(VAS) scores and increased American Orthopaedic Foot & Ankle Society(AOFAS) Ankle-Hindfoot Scores(P<0.05),with the plate fixation group showing greater changes in both VAS scores and AOFAS Ankle-Hindfoot Scores compared to the cannulated screw fixation group(P<0.05).There was no significant difference in the short-term treatment success rate between the two groups(P>0.05).The time to posterior malleolus union and AOFAS Ankle-Hindfoot Scores at 6 and 12 months postoperatively did not differ significantly between the plate fixation group and the cannulated screw fixation group(

关 键 词：三踝骨折 后踝钢板固定 空心螺钉固定 下肢功能 

分 类 号：R683.4[医药卫生—骨科学]