踝关节骨折切开复位内固定术后踝关节镜手术的临床结果

Clinical result of arthroscopic treatment after open reduction and internal fixation of ankle fractures

目的 研究踝关节骨折切开复位内固定(ORIF)手术后再次踝关节镜的疗效。方法 回顾性分析2011年1月至2014 年12月在解放军第81集团军医院骨科因踝关节骨折ORIF手术后各种原因行踝关节镜手术66例患者,平均年龄(40±13)岁。纳入踝关节骨折ORIF术后因残余痛及其他各种原因行踝关节镜手术的患者,排除炎症性关节炎及下肢神经病变、合并精神疾病者。记录术前、术后4周、6月的疼痛视觉模拟评分(VAS)及美国足踝骨科协会踝-后足(AOFAS)评分,记录并发症及处理方法。组间比较采用单因素 ANOVA 方差分析。结果 术后早期无关节镜相关并发症发生。术后4周、6 月VAS评分比术前显著改善( t =2.783, P <0.05), AOFAS评分与术前相比明显升高( t =6.271, P <0.01)。术后4 年再次手术率为19.7%。结论 踝关节骨折ORIF手术后因各种原因行踝关节镜手术早期可以减轻疼痛、改善功能,但中期再手术率高。

Objective To investigate the clinical result of arthroscopic treatment after open reduction and internal fixation (ORIF) of ankle fractures.Methods Sixty-six patients who underwent arthroscopic treatment in Hospital of the NO.81 group of PLA after ORIF of ankle fractures between January 2011 to December 2014 were retrospectively analyzed.Mean age of the patients was (40±13) years.Included criteria were patients undergoing ankle arthroscopic treatment for residual pain and other damage after ORIF of ankle fractures.Patients with inflammatory arthritis,peripheral neuropathy of lower limbs and mental diseases were excluded.Visual analog scale (VAS) and the American Orthopaedic Foot and Ankle Society score (AOFAS) before and four weeks,six months after arthroscopy were recorded.Complications and treatments were recorded.One way ANOVA was used to compare VAS and AOFAS scores among three follow-up time points.Results There was no arthroscopic relative complication in the early stage after surgery.Compared to VAS and AOFAS scores before arthroscopy,those recorded at four weeks and six months were significantly improved (VAS,t =2.783,P<0.05;AOFAS,t =6.271,P<0.01).The reoperation rate at four years was 19.7%.Conclusion Ankle arthroscopy could relieve pain and improve function of ankle after ORIF of ankle fractures,the early result was satisfied but the rate of reoperation was higher in the midterm.