保守治疗与手术治疗踝关节骨折脱位的病例对照研究

Case control study of fractures-dislocations of ankle joint with conservative and operative treatment

目的:比较手法整复外固定与切开复位内固定治疗踝关节骨折脱位旋后-外旋型Ⅲ、Ⅳ度的临床疗效。方法:自2007年9月至2008年12月对收治的踝关节骨折脱位旋后-外旋型Ⅲ、Ⅳ度60例患者进行回顾性分析,其中男32例,女28例;年龄18～70岁,平均37.17岁。60例患者分别采用手法整复石膏外固定治疗(保守组30例)和切开复位内固定治疗(手术组30例)。采用Mazur标准评定踝关节功能;通过X线片观察骨折复位和移位情况;同时对两组患者住院天数与住院费用进行比较。结果:两组患者均获得随访,时间6～25个月,平均15.27个月。踝关节功能按Mazur标准:保守组优16例,良10例,可3例,差1例;手术组优20例,良8例,可2例,差0例。骨折复位和移位情况:保守组优良25例,可4例,差1例;手术组优良28例,可2例,差0例。两组患者在关节功能与X线检查结果方面的差异无统计学意义(P>0.05)。保守组和手术组的住院天数分别为(7.87±3.34)、(17.37±4.64)d;治疗费用分别为(2506.67±649.10)、(11473.33±1564.90)元。两组住院天数、治疗费用有统计学差异(P<0.05)。结论:踝关节骨折脱位旋后-外旋型Ⅲ、Ⅳ度采用保守治疗与手术治疗均能达到很好的治疗效果,但保守治疗安全系数高,经济费用低,能减少患者的医疗费用。

Objective：To compare the clinical efficacy of grade Ⅲ, Ⅳsupination eversion fractures dislocations of ankle joint between manipulative treatment and operative treatment. Methods：From September 2007 to December 2008,the clinical data of 60 patients with gradeⅢ, Ⅳsupination eversion fractures dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females,ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment （conservative group,30 cases） and operative treatment （operative group,30 cases）. The joint function was compared with Mazur standard;the reduction and shifting of fractures were observed with X ray; the hospitalization day and the therapeutic cost were compared between two groups. Results：All patients were followed up with an average of 15.27 months （ranged,6 to 25 months）. In conservative group,16 cases got excellent result in joint function,10 good,3 fair,1 poor;in operative group,20 cases got excellent result,8 good,2 fair,0 poor. In conservative group in the X ray showed 25 cases obtained excellent and good reduction,4 fair,1 poor;and in operative group in the X ray showed 28 cases ob-tained excellent and good reduction,2 fair,0 poor. There was no significant difference at the joint function and X ray film after treatment between two groups （P0.05）. The hospital day was respectively （7.87±3.34）,（17.37±4.64） d in conservative group and operative group;and the therapeutic cost was respectively（2 506.67±649.10）,（11 473.33±1 564.90） yuan. There was sig-nificant difference at hospital day and therapeutic cost between two groups （P0.05）. Conclusion：Conservative treatment and operative treatment can both reach a very good result in treating gradeⅢ, Ⅳsupination eversion fractures and dislocations of ankle joint. However,conservative treatment has advantage of high safety factor,low therapeutic cost,can reduce medical costs for patients.