[1]张碧文.腓骨入路与后外侧入路钢板螺钉内固定治疗旋后外旋型踝关节骨折的对比研究[J].中医正骨,2021,33(06):15-20+41.
 ZHANG Biwen.A comparative study of internal fixation with steel plates and screws through fibular approach versus posterolateral approach for treatment of supination-extorsion-type ankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(06):15-20+41.
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腓骨入路与后外侧入路钢板螺钉内固定治疗旋后外旋型踝关节骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年06期
页码:
15-20+41
栏目:
临床研究
出版日期:
2021-06-20

文章信息/Info

Title:
A comparative study of internal fixation with steel plates and screws through fibular approach versus posterolateral approach for treatment of supination-extorsion-type ankle fractures
作者:
张碧文
仙居县人民医院,浙江 仙居 317300
Author(s):
ZHANG Biwen
Xianju People's Hospital,Xianju 317300,Zhejiang,China
关键词:
踝关节 关节内骨折 骨折固定术 手术入路 临床试验
Keywords:
ankle joint intra-articular fractures fracture fixationinternal operative approach clinical trial
摘要:
目的:比较腓骨入路与后外侧入路钢板螺钉内固定治疗旋后外旋型踝关节骨折的临床疗效和安全性。方法:将符合要求的100例旋后外旋型踝关节骨折患者随机分为2组,每组50例,分别采用后外侧入路钢板螺钉内固定(后外侧入路组)和腓骨入路钢板螺钉内固定(腓骨入路组)治疗。记录并比较2组患者的手术时间、术中出血量、骨折愈合时间、住院时间、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分、简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分、综合疗效和并发症发生情况。结果:①一般指标。2组患者的手术时间、术中出血量及住院时间比较,组间差异均无统计学意义[(115.23±18.35)min,(110.56±15.46)min,t=1.376,P=0.172;(257.62±28.32)mL,(265.35±35.24)mL,t=-1.209,P=0.230;(19.32±3.45)d,(20.23±2.84)d,t=-1.440,P=0.153]; 后外侧入路组患者的骨折愈合时间短于腓骨入路组[(13.56±3.25)周,(17.24±4.12)周,t=-4.959,P=0.000]。②AOFAS踝与后足评分。时间因素和分组因素存在交互效应(F=18.350,P=0.000); 2组患者的AOFAS踝与后足评分总体比较,组间差异有统计学意义,即存在分组效应(F=174.135,P=0.000); 手术前后不同时间点AOFAS踝与后足评分的差异有统计学意义,即存在时间效应(F=486.458,P=0.000); 2组患者的AOFAS踝与后足评分随时间变化均呈上升趋势,但2组的上升趋势不完全一致[(18.56±4.36)分,(42.62±7.82)分,(58.23±6.72)分,(71.28±5.40)分,(82.62±7.35)分,F=524.330,P=0.000;(19.25±5.30)分,(33.47±6.52)分,(45.37±6.25)分,(60.33±7.43)分,(70.34±6.84)分,F=278.400,P=0.000]; 术前2组患者的AOFAS踝与后足评分比较,差异无统计学意义(t=-0.532,P=0.989); 术后1个月、3个月、6个月、12个月,后外侧入路组患者的AOFAS踝与后足评分均高于腓骨入路组(t=7.058,P=0.000; t=9.920,P=0.000; t=8.447,P=0.000; t=9.472,P=0.000)。③SF-36评分。术前2组患者的SF-36评分比较,差异无统计学意义[(56.25±7.34)分,(55.13±6.82)分,t=0.790,P=0.431]; 术后12个月,后外侧入路组患者的SF-36评分高于腓骨入路组[(78.63±6.37)分,(66.38±7.43)分,t=8.851,P=0.000],2组患者的SF-36评分均高于术前(t=-16.283,P=0.000; t=-7.888,P=0.000)。④综合疗效。术后12个月,后外侧入路组优10例、良16例、可12例、差12例,腓骨入路组优18例、良23例、可8例、差1例; 后外侧入路组患者的综合疗效优于腓骨入路组(Z=-3.226,P=0.001)。⑤并发症。后外侧入路组患者术后出现踝关节肿胀3例、切口感染2例,腓骨入路组患者术后出现踝关节肿胀7例、切口感染5例、腓骨肌腱炎2例; 后外侧入路组患者的并发症发生率低于腓骨入路组(χ2=5.263,P=0.022)。结论:相较于腓骨入路钢板螺钉内固定,后外侧入路钢板螺钉内固定治疗旋后外旋型踝关节骨折,能更好地促进骨折愈合、改善踝关节功能、提高生活质量,综合疗效好,安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of internal fixation with steel plates and screws through fibular approach(FA)versus posterolateral approach(PLA)for treatment of supination-extorsion-type ankle fractures.Methods:One hundred patients with supination-extorsion-type ankle fractures were enrolled in the study and were randomly divided into 2 groups,50 cases in each group,and they were treated with steel plates and screws internal fixation through PLA(PLA group)and FA(FA group)respectively.The operative time,intraoperative blood loss,fracture healing time,hospital stays,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores,short form 36 health survey questionnaire(SF-36)scores,total curative effects and complications were recorded and compared between the 2 groups.Results:There was no statistical difference in operative time,intraoperative blood loss and hospital stays between the 2 groups(115.23±18.35 vs 110.56±15.46 minutes,t=1.376,P=0.172; 257.62±28.32 vs 265.35±35.24 mL,t=-1.209,P=0.230; 19.32±3.45 vs 20.23±2.84 days,t=-1.440,P=0.153).The fracture healing time was shorter in PLA group compared to FA group(13.56±3.25 vs 17.24±4.12 weeks,t=-4.959,P=0.000).There was interaction between time factor and group factor in AOFAS ankle-hindfoot scores(F=18.350,P=0.000).There was statistical difference in AOFAS ankle-hindfoot scores between the 2 groups in general,in other words,there was group effect(F=174.135,P=0.000).There was statistical difference in AOFAS ankle-hindfoot scores between different timepoints before and after the surgery,in other words,there was time effect(F=486.458,P=0.000).The AOFAS ankle-hindfoot scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(18.56±4.36,42.62±7.82,58.23±6.72,71.28±5.40,82.62±7.35 points,F=524.330,P=0.000; 19.25±5.30,33.47±6.52,45.37±6.25,60.33±7.43,70.34±6.84 points,F=278.400,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups before the surgery(t=-0.532,P=0.989).The AOFAS ankle-hindfoot scores were higher in PLA group compared to FA group at 1,3,6 and 12 months after the surgery(t=7.058,P=0.000; t=9.920,P=0.000; t=8.447,P=0.000; t=9.472,P=0.000).There was no statistical difference in SF-36 scores between the 2 groups before the surgery(56.25±7.34 vs 55.13±6.82 points,t=0.790,P=0.431).The SF-36 scores were higher in PLA group compared to FA group at 12 months after the surgery(78.63±6.37 vs 66.38±7.43 points,t=8.851,P=0.000),and were higher at 12 months after the surgery compared to pre-surgery in the 2 groups(t=-16.283,P=0.000; t=-7.888,P=0.000).At 12 months after the surgery,10 patients obtained an excellent result,16 good,12 fair and 12 poor in PLA group; while 18 patients obtained an excellent result,23 good,8 fair and 1 poor in FA group.The PLA group surpassed FA group in the total curative effects(Z=-3.226,P=0.001).The ankle swelling(3 cases)and incision infection(2 cases)were found in PLA group; while ankle swelling(7 cases),incision infection(5 cases)and peroneal tendonitis(2 cases)were found in FA group.The incidence rate of postoperative complications was lower in PLA group compared to FA group(χ2=5.263,P=0.022).Conclusion:Internal fixation with steel plates and screws through PLA can better promote fracture healing as well as improve ankle function and patient's life quality compared to internal fixation with steel plates and screws through FA in treatment of supination-extorsion-type ankle fractures,and it exhibits better total curative effect and higher safety.

参考文献/References:

[1] 陈京峰,仝晓明,李治斌.补阳还五汤加减配合切开复位内固定术治疗旋后外旋型踝关节骨折的疗效观察[J].中华中医药学刊,2016,34(4):1021-1024.
[2] JU D G,DEBBI E M,NEUSTEIN A Z,et al.Fibular lengthening osteotomy with revision syndesmotic repair for ankle fracture malunion[J].J Orthop Trauma,2019,33(1):38-39.
[3] YOU J H,KIM I H,HWANG J,et al.Fracture of ankle:MRI using opposed-phase imaging obtained from turbo spinecho modified Dixon image shows improved sensitivity[J].Br J Radiol,2019,91(1088):20170779.
[4] 范智荣,彭嘉杰,钟的桂,等.切开复位内固定是否联合带线锚钉治疗踝关节骨折合并三角韧带损伤的Meta分析[J].中国组织工程研究,2019,23(8):1307-1312.
[5] COUGHLIN M J,SALTZMAN C L,ANDERSON R B.曼氏足踝外科学:第9版[M].唐康来,徐林,译.北京:人民卫生出版社,2015:1893-1894.
[6] 姜矞恒,李莹,王岩.踝关节骨折畸形愈合的诊断与治疗研究进展[J].中华创伤骨科杂志,2017,19(3):268-271.
[7] 龚晓峰,吕艳伟,王金辉,等.踝关节CT与踝关节骨折分型的相关性研究[J].北京大学学报(医学版),2017,49(2):281-285.
[8] 中华医学会.临床诊疗指南:骨科分册[M].北京:人民卫生出版社,2009:122-124.
[9] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005.
[10] 张玉梅,宋鲁平.康复评定常用量表[M].北京:科学技术文献出版社,2018:309-313.
[11] 毕海亮,张起,古恩鹏,等.梯-塔垫在手法复位石膏托和夹板外固定治疗旋后外旋型踝关节骨折中的应用[J].中医正骨,2019,31(7):62-65.
[12] KITAOKA H B,ALEXANDER I J,ADELAAR R S,et al.Clinical rating system for the ankle-hindfoot,midfoot,hal-lux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[13] 季磊,汪玉海,李卫华,等.不同入路内固定术治疗旋后外旋型Ⅳ度踝关节骨折的疗效比较[J].中国运动医学杂志,2020,39(4):263-267.
[14] 冯彦江,杨生民,李西要,等.部分切断下胫腓后韧带浅层辅助复位治疗旋后外旋型踝关节骨折中合并Die-punch骨块的后踝骨折[J].中医正骨,2020,32(8):65-68.
[15] 陈弼国,周业金.旋后外旋型Ⅳ°踝关节骨折中内侧副韧带修复与下胫腓拉力螺钉固定的疗效[J].临床与病理杂志,2019,39(1):84-89.
[16] 李春阳,赵洪涛.腓骨入路切开复位内固定治疗旋后外旋型踝关节骨折[J].中医正骨,2019,31(5):59-61.
[17] 曾林如,汤样华,徐灿达,等.内固定治疗老年旋后外旋型Ⅳ度踝关节骨折[J].中国中西医结合外科杂志,2017,23(3):312-313.
[18] 余智,韩森东.旋后外旋型Ⅲ、Ⅳ度踝关节骨折行经腓骨入路与后外侧入路治疗效果及安全性比较[J].临床外科杂志,2019,27(11):973-976.
[19] LI M,COLLIER R C,HILL B W,et al.Comparing diffrent surgical techniques for addressing the posterior malleolus in supination extemal rotation ankle fractures and the need for syndesmotic screw fixation[J].J Foot Ankle Surg,2017,56(4):730-734.
[20] 周炎,明江华,李亚明,等.经腓骨入路与后外侧入路治疗旋后外旋型Ⅲ、Ⅳ度踝关节骨折的对比研究[J].创伤外科杂志,2017,19(5):343-348.
[21] 陈昌胜,徐明勇,徐众华,等.外踝外侧入路与后外侧入路治疗踝关节骨折的临床效果对比研究[J].湖南师范大学学报(医学版),2019,16(4):99-102.
[22] 熊宏林,周述清,张孝华.不同手术入路及钢板放置位置治疗外踝骨折的临床研究[J].创伤外科杂志,2018,20(7):511-515.
[23] 李鉴明,杨际宇,卞伟,等.抗滑钢板内固定和空心钉内固定对踝关节骨折伴后踝骨折的疗效分析[J].中国医学前沿杂志(电子版),2020,12(1):71-74.
[24] SHANNON S F,HOUDEK M T,WYLES C C,et al.Allg?wer-donati versus vertical mattress suture technique impact on perfusion in ankle fracture surgery:a randomized clinical trial using intraoperative angiography[J].J Orthop Trauma,2017,31(2):97-102.
[25] PARK Y H,YOON M A,CHOI W S,et al.The predictive value of MRI in the syndesmotic instability of ankle frac-ture[J].Skeletal Radiol,2017,47(4):533-540.
[26] 邢艳辉.后外侧入路钢板螺钉内固定对旋后外旋型Ⅳ度踝关节骨折患者术后足踝功能及生活质量的影响[J].河南外科学杂志,2018,24(6):142-143.
[27] 王政权.俯卧位后外侧入路手术治疗旋后外旋型踝部骨折的疗效评价[J].临床医药文献电子杂志,2020,7(22):43.

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备注/Memo

备注/Memo:
通讯作者:张碧文 E-mail:13968481121@163.com
更新日期/Last Update: 2021-12-20