[1]杨威,敖传西,华贤章.非手术疗法和手术疗法治疗B2型踝关节骨折的对比研究[J].中医正骨,2013,25(04):15-17.
　YANG Wei*,AO Chuan-xi,HUA Xian-zhang.*.A retrospective trial of non-operative treatment versus operative treatment for type B2 ankle joint fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(04):15-17.
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非手术疗法和手术疗法治疗B2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25卷
期数:
2013年04期
页码:
15-17
栏目:
足踝损伤
出版日期:
2013-04-30

文章信息/Info

Title:
A retrospective trial of non-operative treatment versus operative treatment for type B2 ankle joint fractures
作者:
杨威; 敖传西; 华贤章
湖北省恩施自治州中心医院,湖北 恩施 445000
Author(s):
YANG Wei*; AO Chuan-xi; HUA Xian-zhang.*
Central Hospital of Enshi Autonomous Prefecture,Enshi 445000,Hubei,China
关键词:
踝关节 骨折 骨牵引复位法 薰洗 切开复位内固定 回顾性研究
Keywords:
Ankle joint;  Fractures; bone;  Skeletal tracting reposition;  Steaming washing therapy;  Open reduction and internal fixation;  Retrospective studies
摘要:
目的:比较非手术疗法和手术疗法治疗B2型踝关节骨折的临床疗效和安全性。方法:回顾性分析33例B2型踝关节骨折患者的病历资料,采用手法复位“U”形石膏固定及中药薰洗治疗者17例(A组),采用切开复位内固定及中药薰洗治疗者16例(B组)。采用Leeds骨折复位评定标准比较2组患者的骨折复位情况,采用Yoshikawa骨痂生长评分标准比较2组患者的骨折愈合情况,采用Mazur踝关节功能评分标准比较2组患者的踝关节功能,同时比较2组患者治疗后并发症发生情况。结果:①骨折复位情况。A组优16例,良1例; B组优16例。2组患者骨折复位情况比较,差异无统计学意义(u=128.000,P=0.332)。②骨折愈合情况。2组患者的骨折均在8周内临床愈合。治疗后不同时间点骨痂生长评分不同(F=697.140,P=0.000); 2组骨痂生长评分总体有差别(F=8.208,P=0.007),进一步比较显示治疗后4周、6周、12周A组骨痂生长均优于B组[(1.66±0.46)分,(1.21±0.30)分,t=3.295,P=0.002;(2.78±0.63)分,(2.37±0.42)分,t=2.235,P=0.033;(3.78±0.47)分,(3.39±0.41)分,t=2.531,P=0.016]; 时间因素与分组因素不存在交互效应(F=0.125,P=0.831)。③踝关节功能。A组踝关节功能Mazur评分为(94.53±2.10)分,B组为(93.56±2.50)分,2组患者踝关节功能比较,差异无统计学意义(t=1.206,P=0.237)。④并发症。2组患者均获随访,随访时间6～12个月,中位数8个月。A组患者治疗后未出现骨折再移位等并发症,B组所有患者的切口均甲级愈合,未发生感染、内固定失败等并发症。结论:对于B2型踝关节骨折,非手术疗法和手术疗法在复位骨折及恢复踝关节功能方面疗效相当,两种疗法的安全性也无明显差异,但非手术疗法更有利于骨痂生长。
Abstract:
Objective:To compare the clinical curative effects and safety between non-operative treatment and operative treatment for type B2 ankle joint fractures.Methods:The clinical records of 33 patients with type B2 ankle joint fractures were analyzed retrospectively.Seventeen patients(group A)were administrated with manipulative reduction and U-shape plaster fixation combined with Chinese medicine steaming washing therapy,while the others(group B)were administrated with open reduction and internal fixation combined with Chinese medicine steaming washing therapy.The fracture reductions were compared between the 2 groups according to Leeds evaluation criteria for fracture reduction,the fracture healing status were compared between the 2 groups according to Yoshikawa scoring criteria for bony callus growth and the ankle joint functions were compared between the 2 groups according to Mazur scoring standard for ankle joint functions.Meanwhile,the posttreatment complications were compared between the 2 groups.Results:Sixteen patients achieved an excellent fracture reduction and 1 fair in group A,while 16 patients achieved an excellent fracture reduction in group B.There was no statistical difference in the result of fracture reduction between the 2 groups(u=128.000,P=0.332).All of the patients in the 2 groups got fracture healing within 8 weeks.There was statistical difference in the bony callus growth scores among posttreatment time points(F=697.140,P=0.000); and there was statistical difference in the bony callus growth scores between the 2 groups totally(F=8.208,P=0.007).Further comparision showed that the bony callus growth scores of group A were higher than those of group B at 4 weeks,6 weeks and 12 weeks after treatment respectively((1.66±0.46),(1.21±0.30),t=3.295,P=0.002;(2.78±0.63),(2.37±0.42),t=2.235,P=0.033;(3.78±0.47),(3.39±0.41),t=2.531,P=0.016).There was no interaction between time factor and grouping factor(F=0.125,P=0.831).There was no statistical difference in Mazur ankle performance scores between the 2 groups((94.53±2.10),(93.56±2.50); t=1.206,P=0.237).All of the patients in the 2 groups were followed up for 6-12 months with a median of 8 months.After treatment,no patients with fracture displacement and other complications were found in group A.All of the patients in group B got primary healing in the operative incisions and no complications such as infection and failed internal fixation were found in group B.Conclusion:For type B2 ankle joint fractures,non-operative treatment and operative treatment have similar curative effects on fracture reduction and ankle joint function restoration,and they are similar to each other in safety,while the former is more helpful to bony callus growth.

参考文献/References:

[1] 陈雁西,俞光荣.踝关节骨折的治疗策略与数字化临床路径[J].中华骨科杂志,2011,31(3):275-284.
[2] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:172.
[3] 王亦璁.骨与关节损伤[M].4版.北京:人民卫生出版社,2007:1501-1503.
[4] Leeds HC,Ehrlich MG.Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures[J].J Bone Joint Surg Am,1984,66(4):490-503.
[5] Yoshikawa H,Rettig WJ,Lane JM,et al.Immunohistochemical detection of bone morphogenetic proteins in bone and soft-tissue sarcomas[J].Cancer,1994,74(3):842-847.
[6] Mazur JM,Schwartz E,Simon SR.Ankle arthrodesis.Long-term follow-up with gait analysis[J].J Bone Joint Surg Am,1979,61(7):964-975.
[7] 罗建成,连海云,王波,等.关节镜在治疗踝关节前踝撞击症中的价值[J].实用骨科杂志,2011,17(8):759-760.
[8] 周一飞,余洋,张小磊,等.手术与手法复位治疗踝关节骨折的临床疗效分析[J].中国骨伤,2012,25(5):404-406.
[9] Weber BG,Simpson LA.Corrective lengthening osteotomy of the fibula[J].Clin Orthop Relat Res,1985,(199):61-67.
[10] Federici A,Sanguineti F,Santolini F.The closed treatment of severe malleolar fractures[J].Acta Orthop Belg,1993,59(2):189-196.
[11] Wei SY,Okereke E,Winiarsky R,et al.Nonoperatively treated displaced bimalleolar and trimalleolar fractures:a 20-year follow-up[J].Foot Ankle Int,1999,20(7):404-407.
[12] Brown OL,Dirschl DR,Obremskey WT.Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures[J].J Orthop Trauma,2001,15(4):271-274.
[13] 肖文庆,杜海峡,程立军,等.切开复位内固定术治疗旋后外旋型Ⅳ度踝关节骨折[J].中医正骨,2012,24(7):48-49.
[14] 张国柱,王满宜.保守治疗旋后-外旋型踝关节骨折的分析[J].中华创伤骨科杂志,2006,8(5):404-406.

备注/Memo

备注/Memo:
2012-12-24收稿 2013-01-25修回
通讯作者:杨威 E-mail:yw_772@163.com
更新日期/Last Update: 2013-04-30