Haraguchi Ⅰ型后踝骨折不同术式疗效对比

Comparison of curative effects of different surgical approaches to Haraguchi type I posterior malleolus fractures

目的比较后路直接切开复位由后向前螺钉内固定和间接闭合复位经皮由前向后螺钉固定治疗HaraguchiⅠ型后踝骨折的疗效。方法收集2015-10至2018-10在武警江苏总队医院手术治疗HaraguchiⅠ型后踝骨折患者的临床资料,根据术式不同分为后路直接切开组(n=41)和闭合复位组(n=38),比较两组疗效。结果两组手术时间及术中出血量和术后并发症等指标,差异均无统计学意义;闭合复位组透视次数[(8.95±0.81)次]多于直接切开组[(6.63±0.74)次],差异有统计学意义(P<0.05)。术后复查X线提示,直接切开组优30例,优秀率73.17%;闭合复位组优12例,优秀率31.58%,直接切开组较闭合复位组有更好的复位效果,差异有统计学意义(P<0.05)。术后1年,两组骨折均完全愈合,无内固定松动、滑脱等,踝关节间隙均无狭窄表现。术后2年直接切开组的AOFA评分[(87.76±2.50)分]高于闭合复位组[(82.03±3.04)分],差异有统计学意义(P<0.05)。结论与闭合复位由前向后螺钉固定相比,后外侧直接切开复位由后向前螺钉固定可更好地复位和固定Haraguchi I型后踝骨折,并获得更好的踝关节功能。

Objective To compare the efficacy of posterior direct open reduction with posterior anterior screw internal fixation and indirect closed reduction with anterior posterior screw fixation in the treatment of Haraguchi typeⅠposterior malleolus fractures.Methods The clinical data on patients with Haraguchi typeⅠankle fractures who had undergone surgery in Jiangsu Corps Hospital of People’s Armed Police Force between October 2015 and October 2018 was collected.According to surgical methods,these patients were divided into the posterior direct open reduction group(n=41)and the indirect closed reduction group(n=38).The difference in efficacy was compared between the two groups.Results There was no significant difference in the duration of surgery,intraoperative blood loss or postoperative complications between the two groups.Fluoroscopy was used more frequently in the indirect closed reduction group(8.95±0.81)than in the direct open reduction group(6.63±0.74),and the difference was statistically significant(P<0.05).According to postoperative X-ray examination,30 cases were excellent in the direct open reduction group,and the excellent rate was 73.17%,compared with 12 cases and 31.58%in the indirect closed reduction group.The reduction quality in the direct open reduction group was significantly better than in the closed reduction group(P<0.05).After one year,fractures of patients in the two groups healed completely.After two years,the AOFA score of the direct open reduction group(87.76±2.50)was significantly higher than that of the indirect closed reduction group(82.03±3.04).Conclusions Direct posterolateral open reduction with posterior and anterior screws can achieve better reduction and fixation of Haraguchi typeⅠposterior malleolus fractures and better ankle function than closed reduction with anterior and posterior screws.