可吸收螺钉治疗不同类型的内踝骨折

Bioabsorbable screws for different types of medial malleolus fractures

目的比较运用生物可吸收螺钉治疗旋前外旋型(PER)、旋前外展型(PAB)Ⅰ~Ⅱ型踝关节骨折效果。方法回顾性分析青岛市西海岸新区中心医院于2015年2月至2017年2月2年内收治的PER、PABⅠ~Ⅱ型踝关节骨折患者。纳入标准:单侧骨折,年龄18~55岁;排除标准:三角韧带断裂或下胫腓前韧带撕脱性骨折,开放性骨折,既往患侧下肢骨折,无法遵嘱功能锻炼。共纳入93例研究对象,PER组39人,PAB组54人。用Mann-Whitney U法比较2组患者术后3个月踝关节的背屈、跖屈角度变化,及踝关节内翻应力位下X线片前后位的踝穴宽度变化。用t检验比较2组患者的踝关节功能美国足踝外科协会评分(AOFAS)。并记录异物反应发生情况。结果术后3个月,PAB组的踝关节的背屈(Z=-3.418,P<0.05)、跖屈(Z=-2.476,P<0.05)角度变化均小于PER组,PAB组的踝关节背屈、跖屈活动恢复较佳。2组患者的踝穴宽度变化差异无统计学意义(Z=-0.296,P>0.05)。术后3个月,PER组踝关节AOFAS功能评分为(84±5)分、PAB组踝关节AOFAS功能评分为(83±5)分,差异无统计学意义(t=1.250,P>0.05),2组患者术后3个月的踝关节功能恢复情况基本一致。PER组有2例(5.1%)、PAB组有1例(1.9%)患者出现轻度异物反应。所有观察对象均未发生断钉。结论运用可吸收螺钉治疗Lauge-Hansen踝关节PER、PABⅠ和Ⅱ型骨折效果确切,PAB患者比PER患者的踝关节背屈、跖屈改善较佳。

Objective To compare the effects of bioabsorbable screws for PER and PAB type I^II ankle fracturesMethods A retrospective analysis of PER,PAB I or PAB II ankle fracture patients treated from Feb 2015 to Feb 2017 in Qingdao West Coast New Area Central Hospital was carried out.Inclusion criteria:unilateral fractures,18 to 55 years old;Exclusion criteria:triangular ligament rupture or avulsion fractures of the anterior tibiofibular syndesmosis,open fractures,previous fractures of the injured lower limbs,unable to follow functional exercise.A total of 93 patients were included,39 cases in the PER group and 54 cases in the PAB group.Mann-Whitney U method was used to compare the changes of dorsiflexion and plantar flexion angles of ankle joints three months after the operation,and the ankle width of anterior-posterior X-ray under varus stress position.The t-test was used to compare the ankle function of the two groups with the American Orthopaedic Foot and Ankle Society(AOFAS)scores.The occurrence of adverse reactions of implants was recorded.Results Three months after the operation,the changes in the ankle dorsiflexion(Z=-3.418,P<0.05)and plantar flexion(Z=-2.476,P<0.05)in the PAB group were less than those in the PER group.The ankle dorsiflexion and plantar flexion activity recovered better in the PAB group.There was no significant difference in ankle width between the two groups(Z=-0.296,P>0.05).The ankle AOFAS function score of the PER group was(84±5)while(83±5)of the PAB group.The recovery of ankle function at 3 months was basically the same of the 2 groups(t=1.250,P>0.05).Two patients(5.1%)in the PER group and one patient(1.9%)in the PAB group had mild foreign body reactions.No screws breakage were observed in all the subjects.Conclusion The use of bioabsorbable screws for the treatment of Lauge-Hansen ankle PER and PAB type I^II fractures is effective,yet the patients of PAB type have better improvements of ankle dorsiflexion and plantar flexion than the PER type patients.