无头加压螺钉和锁定加压钢板在踝关节融合固定中的对比

Comparison of headless compression screw and interlocking compression plate fixation in ankle fusion

背景:踝关节融合是治疗终末期踝关节疾病的重要手段,置入内固定成为目前首选的固定方式,不同的内固定方式导致修复后效果亦不一致。目的:探讨不同内固定方式在踝关节融合固定中的应用效果。方法:回顾性分析2012年9月至2015年3月行踝关节融合内固定的64例患者的临床资料,根据置入内固定方式分为2组,每组32例,观察组行无头加压螺钉内固定治疗,对照组行锁定加压钢板内固定治疗。观察2组患者的切口长度、手术时间、术后引流量、术后并发症、骨融合时间以及踝-后足功能恢复情况,并进行对比分析。结果与结论:(1)在手术时间和骨融合时间方面,2组差异无显著性意义(P>0.05);(2)对照组的切口长度和术后引流量均显著大于观察组,术后并发症发生率显著高于观察组,差异均有显著性意义(P<0.05);(3)治疗前2组美国足踝外科医师协会踝-后足功能评分差异无显著性意义(P>0.05),治疗后末次随访观察组的评分均显著高于对照组(P<0.05);(4)结果表明,与锁定加压钢板相比,应用无头加压螺钉行踝关节融合可以获得更好的内固定效果,创伤小,术后并发症少,固定牢固,更加符合生理和生物力学要求。

BACKGROUND： The ankle fusion is an important treating means of end-stage ankle joint disease. Internal fixation of implant has become the preferred way of fixation, but fixation of different implants has different effects. OBJECTIVE： To explore the value of different internal fixation methods in ankle fusion. METHODS： A retrospective analysis was performed in 64 cases of ankle fusion from September 2012 to March 2015. They were divided into the observation group （32 cases） and control group （32 cases） according to the way of internal fixation of implant. The observation group underwent headless compression screw fixation. The control group underwent interlocking compression plate fixation. Length of incision, operation time, postoperative drainage volume, postoperative complications, healing time of bone and functional recovery of ankle-hindfoot were observed and compared between the two groups. RESULTS AND CONCLUSION： （1） There was no statistical significance in operation time and healing time of bone between the two groups （P 〉 0.05）. （2） Length of incision and postoperative drainage volume were significantly greater in the control group than in the observation group. The incidence of postoperative complications was significantly higher in the control group than in the observation group （P 〈 0.05）. （3） No significant differences in preoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot score were found between the two groups （P 〉 0.05）, but the score was significantly higher in the observation group than in the control group in final follow-up （P 〈 0.05）. （4） These findings suggest that compared with the interlocking compression plate, headless compression screw treatment for ankle fusion can obtain better effect, small trauma, less postoperative complications, fixed firmly, more in line with the physiological and biomechanical requirements.