[1]刘骏逸,刘晓东,李朝晖.腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折的对比研究[J].中医正骨,2021,33(09):15-19.
　LIU Junyi,LIU Xiaodong,LI Zhaohui.A comparative study of open reduction and internal fixation through fibular approach versus malleolar posterolateral approach for treatment of supination-extorsion-type grade Ⅳankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(09):15-19.
点击复制

腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折的对比研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年09期
页码:
15-19
栏目:
临床研究
出版日期:
2021-09-20

文章信息/Info

Title:
A comparative study of open reduction and internal fixation through fibular approach versus malleolar posterolateral approach for treatment of supination-extorsion-type grade Ⅳankle fractures
作者:
刘骏逸; 刘晓东; 李朝晖
(河南省洛阳正骨医院/河南省骨科医院,河南 郑州 450016)
Author(s):
LIU Junyi; LIU Xiaodong; LI Zhaohui
Luoyang Orthopedic-Traumatological Hospital,Zhengzhou 450016,Henan,China
关键词:
踝关节;  骨折固定术; 内;  手术入路;  临床试验
Keywords:
ankle joint;  fracture fixation; internal;  operative approach;  clinical trial
摘要:
目的:比较腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折的临床疗效及安全性。方法:回顾性分析2014年1月至2018年1月收治的122例踝关节旋后外旋型Ⅳ度骨折患者的病例资料,患者均采用切开复位内固定治疗,其中43例采用腓骨入路(腓骨入路组)、79例采用踝关节后外侧入路(后外侧入路组)。记录手术时间、术中出血量,采用Burwell-Charnley放射学复位标准评价术后1周CT检查的踝关节复位质量,采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价术后12个月的综合疗效,观察并发症发生情况。结果:2组患者手术时间、术中出血量及术后12个月的AOFAS踝与后足评分比较,组间差异均无统计学意义[(108.73±14.95)min,(111.75±11.67)min,t=1.279,P=0.763;(189.93±38.46)mL,(201.27±31.88)mL,t=1.593,P=0.126;(89.17±5.12)分,(91.31±4.77)分,t=0.768,P=0.313]。腓骨入路组的复位质量优40例、中3例,后外侧入路组的复位质量优61例、中18例,腓骨入路组的复位质量优于后外侧入路组(χ2=4.883,P=0.027)。2组患者均未出现切口深层感染及骨折不愈合。腓骨入路组出现2例切口浅表感染、1例小腿肌间静脉血栓,后外侧入路组出现3例切口浅表感染、2例切口裂开、1例腓肠神经损伤、2例小腿肌间静脉血栓; 2组患者并发症发生率比较,差异无统计学意义(χ2=0.337,P=0.803)。结论:腓骨入路与踝关节后外侧入路切开复位内固定治疗踝关节旋后外旋型Ⅳ度骨折,在手术时间、术中出血量、综合疗效及并发症发生率方面无明显差异,但采用腓骨入路可以获得更好的复位效果。
Abstract:
Objective:To compare the clinical curative effects and safety of open reduction and internal fixation through fibular approach(FA)versus malleolar posterolateral approach(PLA)for treatment of supination-extorsion-type grade Ⅳ ankle fractures.Methods:The medical records of 122 patients with supination-extorsion-type grade Ⅳ ankle fractures recruited from January 2014 to January 2018 were analyzed retrospectively.Forty-three patients were treated with open reduction and internal fixation through FA(FA group)and 79 ones with open reduction and internal fixation through malleolar PLA(PLA group).The operative time and intraoperative blood loss were recorded and compared between the 2 groups.The ankle reduction outcome checked by CT at 1 week after the surgery was evaluated by using Burwell-Charnley radiological reduction criteria.The total curative effects was evaluated by using American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores at 12 months after the surgery,and the complications were observed.Results:There was no statistical difference in operative time,intraoperative blood loss and AOFAS ankle-hindfoot scores measured at 12 months after the surgery between the 2 groups(108.73±14.95 vs 111.75±11.67 minutes,t=1.279,P=0.763; 189.93±38.46 vs 201.27±31.88 mL,t=1.593,P=0.126; 89.17±5.12 vs 91.31±4.77 points,t=0.768,P=0.313).The ankle reduction outcome was evaluated according to Burwell-Charnley radiological reduction criteria,40 patients got an excellent result and 3 fair in FA group; while 61 patients obtained an excellent result and 18 fair in PLA group.The ankle reduction outcome was better in FA group compared to PLA group(χ2=4.883,P=0.027).The complications such as deep incision infection and fracture nonunion were unfound in the 2 groups; whereas the superficial incision infection(2 cases)and intramuscular calf vein thrombosis(1 case)were found in FA group,and the superficial incision infection(3 cases),incision dehiscence(2 cases),sural nerve injuries(1 case)and intramuscular calf vein thrombosis(2 cases)were found in PLA group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.337,P=0.803).Conclusion:There is no obvious difference in operative time,intraoperative blood loss,total curative effects and complication incidence between FA and malleolar PLA in open reduction and internal fixation for treatment of supination-extorsion-type grade Ⅳ ankle fractures,however,the former has such advantages as better ankle reduction outcome.

参考文献/References:

[1] ABDELGAWAD A A,KADOUS A,KANLIC E.Posterolateral approach for treatment of posterior malleolus fracture of the ankle[J].J Foot Ankle Surg,2011,50(5):607-611.
[2] SWITAJ P J,WEATHERFORD B,FUCHS D,et al.Evalu-ation of posterior malleolar fractures and the posterior pilon variant in operatively treated ankle fractures[J].Foot Ankle Int,2014,35(9):886-895.
[3] GONZALEZ T A,WATKINS C,DRUMMOND R,et al.Transfibular approach to posterior malleolus fracture fix-ation:technique tip[J].Foot Ankle Int,2016,37(4):440-445.
[4] GIL J A,GOODMAN A D,KLEINER J,et al.Mortality and morbidity of surgical management of geriatric ankle fractures[J].J Am Acad Orthop Surg,2020,28(16):678-683.
[5] COLES C P,TORNETTA P 3rd,OBREMSKEY W T,et al.Ankle fractures:an expert survey of orthopaedic trauma association members and evidence-based treatment recommendations[J].J Orthop Trauma,2019,33(9):e318-e324.
[6] 王亦璁,姜保国.骨与关节损伤[M].5版.北京:人民卫生出版社,2012:1418-1419.
[7] 王琰,张华锴,王丹,等.舒筋活血汤联合中医康复治疗对踝关节骨折术后恢复的影响[J].中华中医药学刊,2021,39(4):102-105.
[8] BüKER N,SAVKIN R,? N.Comparison of supervised exercise and home exercise after ankle fracture[J].J Foot Ankle Surg,2019,58(5):822-827.
[9] 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,2015:1891-1892.
[10] CHOU L B.足踝外科新进展:第5版[M].武勇,译.北京:人民卫生出版社,2018:845-848.
[11] 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.
[12] 马梓元,郭胜洋,高峰,等.经后外侧入路钢板和螺钉内固定治疗后踝骨折疗效比较[J].中国修复重建外科杂志,2021,35(4):431-438.
[13] PALMANOVICH E,OHANA N,YAACOBI E,et al.Pre-operative planning and surgical technique for optimizing internal fixation of posterior malleolar fractures:CT versus standard radiographs[J].J Orthop Surg Res,2020,15(1):119.
[14] ARTHUR D,PYLE C,SHYMON S J,et al.Correlating arthroscopic and radiographic findings of deep deltoid ligament injuries in rotational ankle fractures[J].Foot Ankle Int,2021,42(3):251-256.
[15] 陈宏峰,杨冬松,李真,等.全层修复三角韧带与下胫腓联合内固定治疗Lauge-Hansen旋后外旋型Ⅳ度踝关节骨折[J].中国骨与关节损伤杂志,2021,36(2):205-207.
[16] 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.
[17] 毕大鹏,俞胜宝,田竞,等.踝关节骨折畸形愈合的治疗进展[J].足踝外科电子杂志,2019,6(3):45-48.
[18] 张经,王斌,乔文,等.三角韧带合并下胫腓联合损伤的微创治疗进展[J].中华关节外科杂志(电子版),2021,15(1):104-110.
[19] 沈国栋,杨康勇,赖志斌,等.新鲜标本的下胫腓联合韧带解剖特点及临床意义[J].解剖学杂志,2021,44(1):49-52.
[20] MASON L W,MARLOW W J,WIDNALL J,et al.Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle[J].Foot Ankle Int,2017,38(11):1229-1235.
[21] 周玮,李建有,何剑,等.螺旋CT三维重建技术在踝关节骨折术前分型和术后评估中的应用价值[J].医学影像学杂志,2015,25(12):2220-2224.
[22] 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.
[23] 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.
[24] 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.
[25] 许岩,段德宇,贺磊,等.下胫腓联合损伤的诊疗进展[J].中国矫形外科杂志,2020,28(22):2077-2081.

相似文献/References:

[1]江涛,江林,史俊德,等.动气针法在踝关节骨折术后中后期康复中的应用[J].中医正骨,2015,27(11):20.
　JIANG Tao,JIANG Lin,SHI Junde,et al.Application of Dongqi acupuncture(动气针法)to postoperative rehabilitation in the middle-late period in patients with ankle joint fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(09):20.
[2]温超海,何忠,李永斌,等.闭合复位伽玛钉改良成锁定支架内固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(11):32.
[3]肖善富,张喜善,于凤珍.髌下小切口钢丝纽扣式内固定治疗胫骨髁间隆突骨折[J].中医正骨,2015,27(11):34.
[4]方华宴,李兴华,王爱国.手术治疗踝关节骨折手术失败导致的复杂陈旧性踝关节脱位[J].中医正骨,2015,27(11):45.
[5]朱峰,宋相建,吴蔚,等.手法复位经皮克氏针内固定治疗 儿童闭合性肱骨远端全骨骺分离[J].中医正骨,2015,27(11):51.
[6]裘人华,胡培阳,裘天强,等.闭合复位外固定架固定治疗Colles骨折[J].中医正骨,2015,27(11):59.
[7]葛波涌,王玉波,王明太,等.交锁髓内钉内固定治疗胫骨干骨折的临床研究[J].中医正骨,2015,27(10):8.
　GE Boyong,WANG Yubo,WANG Mingtai,et al.Clinical study on the internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(09):8.
[8]邓红敏,刘志诚.转子间斜行截骨结合股骨近端防旋髓内钉固定治疗 股骨近端骨折术后髋内翻畸形[J].中医正骨,2015,27(10):17.
[9]孙群周,阮成群,李光明,等.股骨近端防旋髓内钉内固定治疗 老年不稳定型股骨转子间骨折[J].中医正骨,2015,27(10):20.
[10]方策,倪新宇,王宏伟,等.迟氏正骨手法复位单臂外固定支架固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(10):22.
[11]刘 超.续骨活血汤和接骨紫金丹在三踝骨折治疗中的应用[J].中医正骨,2015,27(06):57.
[12]徐善强,巫宗德,徐强,等.经皮微创内固定术治疗C型Danis-Weber踝关节骨折[J].中医正骨,2016,28(02):49.
[13]翁祝承,陈金洪.切开复位内固定结合韧带修复重建治疗旋前-外旋型踝关节骨折[J].中医正骨,2017,29(02):55.
[14]赵洪涛.锁定钢板联合拉力螺钉内固定治疗踝关节骨折合并下胫腓分离[J].中医正骨,2017,29(03):67.
[15]包学迅,王贺辉,郁耀平,等.TightRope钢板内固定治疗三踝骨折合并下胫腓联合损伤[J].中医正骨,2017,29(08):65.
[16]王慧彪,塔依尔·牙合甫.切开复位内固定治疗旋后、旋前外旋型Ⅳ度踝关节骨折[J].中医正骨,2017,29(10):78.
[17]邵加龙,许平,杜薛平,等.后外侧联合后内侧入路切开复位支撑钢板内固定 治疗KlammerⅡ、Ⅲ型后侧Pilon骨折[J].中医正骨,2018,30(08):63.
[18]董磊,姜宏.切开复位内固定治疗Logsplitter损伤[J].中医正骨,2018,30(11):77.
[19]尚林,王翔宇,王爱国,等.旋后内收型Ⅱ度踝关节骨折术后内踝固定失败原因分析及对策[J].中医正骨,2019,31(03):75.
[20]苏攀,赵鹏,穆世民,等.Gatellier-Chastang后外侧入路治疗合并Die-punch骨块的后踝骨折[J].中医正骨,2019,31(05):55.

更新日期/Last Update: 1900-01-01