急诊手术处理踝关节骨折合并脱位患者临床效果观察

Clinical effect of emergency operation on ankle joint fracture and dislocation

目的探讨急诊手术与择期手术处理踝关节骨折合并脱位的临床效果。方法选取2013年6月至2015年6月符合研究选取标准的踝关节骨折合并脱位患者72例，根据手术时机不同分为研究组与对照组，每组36例。研究组行急诊手术，对照组行择期手术。术后1年对患者进行随访，对比两组手术情况（手术用时、住院时间、骨折愈合时间、医疗费用）、治疗前后两组疼痛程度评分及日常生活活动能力评分变化情况，并统计两组临床疗效及并发症发生率。结果两组手术用时、骨折愈合时间比较差异未见统计学意义（P〉0．05）；但研究组住院时间及医疗费用明显少于对照组，差异有统计学意义（P〈0．05）。研究组治疗优良率为88．89％，对照组为86．11％，两组比较差异未见统计学意义（P〉0．05）。研究组创伤性关节炎、骨折延迟愈合、皮肤坏死、切口延迟愈合及切口感染发生率与对照组比较差异未见统计学意义（P〉0．05）。术前两组VAS及Barthel指数评分比较差异未见统计学意义（P〉0．05）；治疗后，两组各指标评分均较术前显著改善（P〈0．05）。结论对踝关节骨折合并脱位患者采用急诊手术及择期手术疗效相当，均对缓解疼痛感、提高日常生活活动能力具有重要意义，且安全性较高，但急诊手术可减少住院时间及医疗费用，具有推广价值。

Objective To investigate the clinical effect of emergency operation and selective operation on ankle joint fracture and dislocation. Methods Seventy-two patients with ankle joint fracture and dislocation were selected from June 2013 to June 2015. According to the different timing of surgery, they were divided into study group and control group, with 36 cases in each group. The study group was treated by emergency surgery, and the control group was treated by underwent elective surgery. After 1 year of follow up, operation indicators such as operation time, hospitalization time, fracture healing time, medical expenses before and after the treatment, and pain score and activities of daily living ability score change of the two groups were compared ; with incidence of clinical efficacy and complications of the two groups were also recorded. Results There was no significant difference in the time of fracture healing between the two groups （P 〉 0. 05 ）. However, the hospitalization time and medical expenses in the study group were significantly less than those in the control group, the differences were significant （P 〈 0.05）. The excellent and good rate of the study group was 88.89% and 86. 11% in the control group, the difference was not significant （P 〉 0. 05） ; There were no significant difference in traumatic arthritis, fracture delayed healing, skin necrosis, delayed healing of the incision or incision infection rate between the two groups （ P 〉 0.05 ）. There was no significant difference between the two groups in VAS or Barthel index score （P 〉 0.05 ）, and the scores of each index of the two groups significantly improved after treatment （P 〈 0. 05 ）. Conclusions The emergency surgery and elective surgery in the treatment of ankle joint fracture and dislocation has equivalent efficacy and can both relieve the pain sense and improve the ability of activities of daily living with high safety. However, emergency operation can reduce hospitalization time and costs with wide application.