摘要
目的比较外侧中和钢板和后外侧解剖钢板治疗骨质疏松性外踝骨折的疗效。方法本组共44例,其中男25例,女19例;按照治疗方法分为外侧中和钢板组(24例),其中男13例,女11例,平均年龄(69.6±15.8)岁(60~84岁),术前腰椎骨密度(0.889±0.104)g/cm^2,股骨颈骨密度(0.675±0.092)g/cm^2;后外侧解剖钢板组(20例),其中男12例,女8例,平均年龄(67.9±13.2)岁(60~78岁),术前腰椎骨密度(0.925±0.093)g/cm^2,股骨颈骨密度(0.568±0.062)g/cm^2;平均术前住院时间分别为4.8天和4.5天。致伤原因:平地摔伤24例,自行车摔伤4例,楼梯扭伤16例;根据影像学旋后外旋型损伤分度:II度(单纯的外踝骨折)7例,III度(外踝和胫骨远端后外侧骨折)4例,IV度(外踝、胫骨远端后外侧及内踝骨折)33例。术后采用美国足踝外科协会后足踝评分系统(American orthopedic foot ankle society,AOFAS)对两组的疗效和并发症进行评价。结果44例获平均17(12~25)个月随访,两组的性别比例、年龄、合并症、旋后外旋型骨折分度、术前住院时间和股骨颈骨密度相比,差异无统计学意义(P>0.05)。两组平均手术时间和术中出血量对比差异无统计学意义(P=0.29,0.26)。术后12个月随访AOFAS评分:外侧中和钢板和抗滑钢板组分别为平均(93.7±6.1)分和(94.5±6.0)分,两组比较差异无统计学意义(P=0.38)。切口相关并发症:外侧中和钢板组9例并发切口感染和内固定激惹等,后外侧抗滑钢板固定组并发内固定激惹和腓骨肌腱病各1例,两组相比差异有统计学意义(P=0.04)。结论两种方法治疗骨质疏松性旋后外旋型外踝骨折均安全有效,但后外侧解剖钢板可以减少切口局部并发症的发生。
Objective To compare effects and complications between lateral neutralization plating and posterolateral anatomic plating for lateral malleolus fractures in the elderly.Methods A total of 44 patients were included.All were divided into 2 groups:lateral neutralization plating group;posterolateral anatomic plating group.Lateral neutralization plating group(n=24):13 males and 11 females;the mean age was(69.6±15.8)years(range:60-84 years);bone mineral density of lumbar and femoral neck were(0.889±0.104)and(0.675±0.092)g/cm^2.Posterolateral anatomic plating group(n=20):12 males and 8 females;the mean age was(67.9±13.2)years(range:60-78 years);bone mineral density of lumbar and femoral neck were(0.925±0.093)and(0.568±0.062)g/cm^2.The average preoperative hospital stay was 4.8 d and 4.5 d respectively.Causes of the injury:falls in 24 patients,falls during cycling in 4 and falls from stairs in 16.According to supination external rotation subtype of Lauge-Hansen classification,7 patients had subtypeⅡ,4 subtypeⅢ,and 33 subtypeⅣ.Clinical outcomes and postoperative complications were analyzed by American Orthopedic Foot Ankle Society,(AOFAS)scores.Results All patients were followed for 12-25 months(average:17 months).There were no significant differences in gender,age,comorbidities,supination and external rotation classification,preoperative hospital stay and femoral neck bone density between the 2 groups(P>0.05).There were no significant differences in the mean operative time and intraoperative blood loss between the 2 groups(P=0.29,0.26).AOFAS:the mean score of(93.7±6.1)in the lateral neutralization plate group,and(94.5±6.0)in the posterolateral plating group;with no significant differences(P=0.38).Complications:9 patients of incision infection and internal fixation irritation in the lateral neutralization plate group;1 internal fixation irritation and 1 fibula tendon disease in the posterolateral plating group;with significant differences between the 2 groups(P=0.04).Conclusions Both procedures are effective,while posterolateral plating can reduce soft tissue complications.
作者
刘勇
陈国川
俞玮
张富宁
LIU Yong;CHEN Guo-chuan;YU Wei;ZHANG Fu-ning(The second Department of Orthopedics,Ningxia Hui AutonomousRegion Corps Hospital,Chinese People's Armed Police Force,Yinchucin,Ningxia,750004,China)
出处
《中国骨与关节杂志》
CAS
2019年第3期196-200,共5页
Chinese Journal of Bone and Joint
关键词
骨质疏松性骨折
踝骨折
骨折固定术
内
Osteoporotic fractures
Ankle fractures
Fracture fixation,internal