中西医结合治疗在踝关节骨折中的疗效观察

Clinical Observation of Intergrated Traditional Chinese and Western Medicine in Treating Posterior Malleolas Fracture

目的:观察中西医结合治疗内踝或/和外踝骨折合并后踝骨折的疗效。方法:选择我院骨科2014年2月—2015年10月行内固定手术联合中药治疗的合并后踝骨折的踝关节骨折40例患者资料,经后外侧入路切开复位内固定23例(切开复位组),闭合复位内固定并联合中药治疗17例(闭合复位联合中药组)。观察两组患者手术时间、术后非负重时间、骨折愈合时间及患者手术并发症情况。根据Olerud-Molander踝关节评分系统对两组患者术后12个月的踝关节功能进行评分比较。结果:切开复位组患者的手术时间、术后骨折愈合时间较闭合复位联合中药组长,差异有统计学意义(P<0.05)。两组患者术后6周逐渐下地行负重锻炼,术后非负重时间差异无统计学意义(P>0.05)。所有手术患者均在5~7个月内获得临床愈合,随访12~16个月。切开复位组伤口感染3例。闭合复位联合中药组踝关节塌陷1例,踝关节疼痛1例。切开复位组患者踝关节功能评分为(82.64±8.34)分,其中优16例,良4例,可3例,差0例;闭合复位联合中药组患者踝关节功能评分为(80.68±9.47)分,其中优12例,良3例,可1例,差1例,两组患者踝关节功能评分差异无统计学意义(P>0.05)。结论:经后外侧入路切开复位内固定与闭合复位内固定联合中药在治疗踝关节骨折中的临床效果相似。切开复位内固定手术时间长,局部软组织损伤重,闭合复位内固定联合中药治疗技术要求高,术中情况复杂,术后需要口服中药治疗。对于单一的内踝及后踝骨折可选用闭合复位,对于合并内外踝及后踝的骨折建议行经后外侧入路切开复位。

Objective To investigate the clinical effect of integrated traditional Chinese and Western medicine for treating involved posterior malleolus fracture.Methods The clinical data of 40 patients with involved posterior malleolar fracture undergoing hollow screw internal fixation by open reduction or closed reduction and TCM therapy in Nanyuan Hospital from February 2012 to October 2015 were retrospectively analyzed,including 23 cases of lateral approach with open reduction and 17 cases of closed reduction and TCM therapy.The operation time,fracture healing time,postoperative non-weight-bearing time and complications were recorded and compared between the two groups.The ankle joint function at postoperative 12 months in the two groups was evaluated by Olerud-Molander.Results The operating time and facture healing time in the closed reduction group were obviously shorter than those in the lateral approach with open reduction group,the differences were statistically significant(P<0.05).The patients in the two groups gradually began to conduct loaded exercise at about postoperative 6 weeks.The postoperative non-weight-bearing time had no statistical difference between the two groups(P>0.05).The two groups obtained the bony healing during 5–7 months follow up.The lateral approach with open reduction group had 3 cases of superficial infection.The closed reduction group had 1 case of articular surface collapse and 1 case of pain.The ankle joint function score in the lateral approach with open reduction group was(83.51±8.44)points,in which 16 cases were excellent,4 cases were good,3 cases were fair and 0 case was poor;the ankle joint function score in the closed reduction group was(80.83±9.61)points,in which 12 cases were excellent,3 cases were good,1 case was fair and 1 case was poor,the articular function score had no statistical difference between the two groups(P>0.05).Conclusion The clinical effect of open reduction and internal fixation with posterolateral approach is similar to that of closed reduction and TCM therapy and internal fixation in the treatment of ankle fracture.The operation time of open reduction and internal fixation is long,local soft tissue injury is heavy,closed reduction and internal fixation requires high technology,and the operation time is short.For a single posterior malleolus fracture,a closed reduction is recommended,and for fractures with medial and lateral malleolus,open reduction via a posterolateral approach is recommended.