不同手术入路对AO-C型Pilon骨折患者踝关节功能及炎症与应激状态的影响  

Effects of different surgical approaches on ankle function,inflammation and stress state in patients with AO type C pilon fractures

作　　者：王洪超 张明伦 关德强 陈占伟 孙天赐 陈健 WANG Hong-chao;ZHANG Ming-lun;GUAN De-qiang;CHEN Zhan-wei;SUN Tian-ci;CHEN Jian(The First Department of Bone Trauma,Liaocheng Traditional Chinese Medicine Hospital,Liaocheng,Shandong,252000,China)

机构地区：[1]聊城市中医医院骨创伤一科,山东省252000 [2]聊城市中医医院手术室,山东省252000 [3]聊城市中医医院骨创伤二科,山东省252000

出　　处：《中国骨与关节杂志》2025年第3期242-247,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析不同手术入路对AO-C型Pilon骨折患者美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分及炎症、应激状态的影响。方法回顾分析2020年1月至2023年1月诊治的100例AO-C型Pilon骨折患者临床资料,按照手术入路方式不同将患者分为A组(n=50)和B组(n=50),A组采用前外侧入路,B组行前外侧入路联合内侧微创入路,行切开复位内固定术,记录两组患者围术期相关指标、AOFAS踝-后足评分、炎症指标[C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、应激指标[血清去甲肾上腺素(Norepinephrine,NE)、肾上腺素(adrenaline,E)、皮质醇(cortisol,Cor)]以及并发症发生率。结果B组术中出血量较A组更少[(75.18±8.22)ml vs.(86.94±9.46)ml],骨折愈合时间较A组更短[(95.50±8.52)天vs.(101.50±9.07)天],差异有统计学意义(P<0.05)。B组术后3个月及6个月AOFAS踝-后足评分均高于A组[(63.30±7.08)vs.(58.38±6.21)、(91.34±8.36)vs.(85.68±8.01)],差异有统计学意义(P<0.05)。B组术后1个月VAS评分低于A组[(1.39±0.18)vs.(2.11±0.25)],差异有统计学意义(P<0.05)。术前两组血清CRP、IL-6、TNF-α、NE、E、Cor水平对比差异无统计学意义(P>0.05),术后1天,B组CRP、IL-6、TNF-α水平低于A组[(6.85±0.45)mg/L vs.(7.33±0.57)mg/L、(7.22±0.85)ng/L vs.(9.25±0.96)ng/L、(18.98±2.19)ng/L vs.(25.48±3.27)ng/L],差异均有统计学意义(P<0.05)。术后1天,B组NE、E、Cor水平低于A组[(123.58±13.56)ng/ml vs.(152.37±16.25)ng/ml、(102.38±11.38)ng/ml vs.(162.26±17.56)ng/ml、(20.39±2.42)U/ml vs.(26.36±3.21)U/ml],差异均有统计学意义(P<0.05)。B组并发症发生率(2%)低于A组(10%),但差异无统计学意义(χ^(2)=2.837,P=0.204)。结论前外侧入路联合内侧微创入路治疗AO-C型Pilon骨折临床效果明显,可促进踝关节功能恢复,减少术后炎症反应及应激反应。Objective To analyze the effects of different surgical approaches on the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,inflammation and stress state of patients with AO type C pilon fractures.Methods The clinical data of 100 patients with AO type C pilon fractures treated at the hospital from January 2020 to January 2023 were retrospectively analyzed.According to different surgical approaches,the patients were divided into group A(n=50,open reduction and internal fixation via anterolateral approach)and group B(n=50,open reduction and internal fixation via anterolateral approach combined with medial minimally invasive approach).Perioperative related indicators,AOFAS ankle-hindfoot scores,inflammatory indicators[C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)],stress indicators[serum norepinephrine(NE),epinephrine(E)and cortisol(Cor)],and the incidence rates of complications in the two groups were recorded.Results Compared with group A,intraoperative blood loss of group B was less[(75.18±8.22)ml vs.(86.94±9.46)ml]and fracture healing time of group B was shorter[(95.50±8.52)d vs.(101.50±9.07)d],with statistically significant differences(P<0.05).At 3 and 6 months after surgery,AOFAS ankle-hindfoot scores of group B were higher than those of group A[(63.30±7.08)vs.(58.38±6.21),(91.34±8.36)vs.(85.68±8.01)],and the differences were statistically significant(P<0.05).At 1 month after surgery,VAS score of group B was lower than that of group A[(1.39±0.18)vs.(2.11±0.25)],and the differences were statistically significant(P<0.05).There were no statistically significant differences in serum CRP,IL-6,TNF-α,NE,E and Cor levels between the two groups before surgery(P>0.05).On day 1 after surgery,the levels of CRP,IL-6 and TNF-αin group B were lower than those in group A[(6.85±0.45)mg/L vs.(7.33±0.57)mg/L,(7.22±0.85)ng/L vs.(9.25±0.96)ng/L,(18.98±2.19)ng/L vs.(25.48±3.27)ng/L].On day 1 after surgery,the levels of NE,E and Cor in group B were lower than

关 键 词：胫骨骨折 骨折固定术 内 炎症 应激 生理学 

分 类 号：R683.4[医药卫生—骨科学]