内踝截骨入路和内、外侧联合入路治疗距骨颈骨折的疗效对比

Comparison of efficacy of inner ankle amputated bone into the path and the inner and outer joint into the path treatment from the bone neck fracture

目的对比内踝截骨入路和内、外侧联合入路治疗距骨颈骨折的疗效。方法以2013年7月—2018年6月本院收治的22例距骨颈骨折患者为研究对象。随机分为内踝截骨入路和内、外侧联合入路组,各11例。对比两组患者术后1年的治疗效果。结果随访1年后,内踝截骨手术入路组创伤性关节炎发生率(45.5%)高于内、外侧联合入路(9.1%),差异有统计学意义(P=0.04);两组患者距骨缺血性坏死发生率对比(45.5%vs 27.3%),差异无统计学意义(P=0.37)。术后1年内踝截骨入路组VAS评分(3.27±1.85)分,术后恢复优良率为45.5%(5/11);内、外侧联合入路组VAS评分(4.82±1.54)分,术后恢复优良率为27.3%(3/11)。两组术后恢复情况比较,差异无统计学意义(P=0.64);内、外侧联合入路组VAS评分明显高于内踝截骨组,差异有统计学意义(t=-2.13,P=0.04)。结论对于距骨颈骨折患者,内、外侧联合入路治疗较内踝截骨入路更能保留内踝完整,减少因内踝截骨产生的对位不良,进而减少创伤性关节炎的发生率,提高术后愈合率;同时,内、外侧联合入路能更广泛地显露手术视野,彻底清除骨折断端碎骨片,达到更好的复位效果。临床中术者具体选择手术入路可结合自身手术技术掌握情况、骨折类型及患者自身情况。

Objective To compare the efficacy of the medial malleolus osteotomy approach and the medial and lateral approach in the treatment of talar neck fractures.Methods Twenty-two patients who underwent surgical treatment in our hospital for talus neck fracture from July 2013 to June 2018 were selected as subjects.All patients were randomly divided into two groups:11 patients in the group of medial malleolus osteotomies and 11 patients in the group of medial and lateral approach in order to compare the therapeutic effects within one year after surgery.Results One year after follow-up,the incidence of traumatic arthritis(45.5%)in the medial malleolus osteotomy was significantly higher than that in the medial and lateral approach(9.1%)(P=0.04).There was no significant difference in the incidence of ischemic femoral head necrosis between the two groups(45.5%vs27.3%)(P=0.37).One year after operation,the VAS score of the medial malleolus osteotomy group was(3.27±1.85),the excellent and good rate of postoperative recovery was 45.5%(5/11);the VAS score of the medial and lateral approach group was(4.82±1.54),the excellent and good rate of postoperative recovery was 27.3%(3/11).There was no significant difference in postoperative recovery between the two groups(P=0.64);the VAS score of the medial and lateral approach group was significantly higher than that of the medial malleolus osteotomy group(t=-2.13,P=0.04).Conclusion For the patients with fracture of talar neck,the medial and lateral approach combined approach can preserve the integrity of the medial malleolus compared with the medial malleolus osteotomy approach,which alleviated the malalignment caused by the medial malleolus osteotomy,and thus reducing the incidence of traumatic arthritis and improving the postoperative healing rate.Meanwhile,the combined medial and lateral approach could achieve better surgical view and was helpful to remove fracture fragments completely so as to achieve better reset effect.The selection of the specific approach shall be conducted in consideration of surgical skills,fracture type and the patient’s condition.