关节镜下埋头钉内固定术治疗距骨骨折疗效观察

Efficacy of arthroscopic internal fixation with countersunk screw in the treatment of talus fracture

目的探讨关节镜下埋头钉内固定术治疗距骨骨折的临床效果。方法选取2015年1月至2018年12月在怀集县人民医院骨科治疗的48例距骨骨折患者进行研究,采用随机数表法将患者分为观察组和对照组,每组24例。观察组行关节镜下距骨骨折埋头钉内固定术,对照组行传统切开复位内固定术治疗,术后3个月评价临床疗效,并比较两组患者术前、术后踝关节功能、骨折愈合时间、住院时间和并发症发生情况。结果观察组患者的治疗总有效率为91.67%,明显高于对照组的66.67%,差异有统计学意义(P<0.05);对照组和观察组患者术前的踝关节功能评分(AOFAS)分别为(42.08±4.29)分、(41.75±5.31)分,差异无统计学意义(P>0.05);术后两组患者的AOFAS评分均明显高于术前,且观察组明显高于对照组[(66.28±7.51)分vs(53.04±6.79)分],差异均有统计学意义(P<0.05);观察组患者骨折愈合时间及住院时间分别为(3.19±1.04)个月,(3.57±0.97)d,明显短于对照组的(4.18±1.25)个月,(8.28±2.54)d,差异均有统计学意义(P<0.05);对照组患者的并发症总发生率为20.83%,略高于观察组的8.33%,但差异无统计学意义(P>0.05)。结论关节腔镜下埋头钉内固定术治疗距骨骨折较传统切开复位内固定术更能明显提高患者的疗效,改善踝关节功能,缩短骨折愈合时间及住院时间,且不增加并发症发生率。

Objective To explore the clinical effect of arthroscopic internal fixation with countersunk screw in the treatment of talus fracture.Methods Forty-eight patients with talus fracture treated in Huaiji County People's Hospital from January 2015 to December 2018 were selected for the study.The patients were divided into two groups by random number table method,with 24 patients in each group.The patients in the control group were treated with traditional open reduction and internal fixation,while the patients in the observation group were treated with arthroscopic internal fixation with countersunk screw.The clinical efficacy of the patients was evaluated 3 months after operation.The preoperative and postoperative ankle joint functions were compared between the two groups,as well as the fracture-healing time,hospitalization time,and complications were recorded.Results The total effective rate of the observation group was 91.67%,which was significantly higher than 66.67%in the control group(P<0.05).There was no significant difference in ankle function score(AOFAS)between the two groups before operation:(42.08±4.29)vs(41.75±5.31),P>0.05;the AOFAS scores of the two groups after operation were significantly increased than those before operation,and the score of the observation group was significantly higher than that of the control group:(66.28±7.51)vs(53.04±6.79),P<0.05.The healing time and hospitalization time in the observation group were(3.19±1.04)months and(3.57±0.97)days,which were significantly shorter than(4.18±1.25)months and(8.28±2.54)days in the control group(P<0.05).The total incidence of complications in the control group was 20.83%,which was significantly higher than 8.33%in the observation group(P>0.05).Conclusion Arthroscopic internal fixation with countersunk screw can significantly improve the curative effect,ankle function,fracture-healing time,and hospitalization time in patients with talus fracture,as compared with traditional open reduction and internal fixation,which does not increase the incidence of complications.