分段渐变螺距中空埋头加压螺钉和普通空心半螺纹加压螺钉治疗内踝骨折的效果评估

Effect of headless reduction screws and common headless compression screws in the treatment of medial malleolus fractures

背景:分段渐变螺距中空埋头加压螺钉是一种经过改进的中空螺钉,治疗内踝骨折时与传统的普通空心半螺纹加压螺钉相比,临床资料较为缺乏。目的:比较分段渐变螺距中空埋头加压螺钉和普通空心半螺纹加压螺钉修复内踝骨折的效果。方法:回顾性分析成都大学附属医院骨科于2016年7月至2018年10月间收治的内踝骨折患者100例,其中渐变螺距螺钉组50例采用分段渐变螺距中空埋头加压螺钉行骨折内固定,普通空心螺钉组50例采用普通空心半螺纹加压螺钉行骨折内固定,于术后观察各组踝关节影像学评估骨折愈合时间、并发症发生及AOFAS评分的差异。结果与结论:①在术后6周-18个月的随访周期内,两组患者的骨折愈合时间、AOFAS评分均差异无显著性意义(P> 0.05);②并发症分析:渐变螺距螺钉组术后7个月延迟愈合1例,术后12个月内固定断裂1例;普通空心螺钉组术后2 d伤口感染1例,术后3个月静脉血栓1例,术后6,9个月延迟愈合2例,术后1 d复查发现加压过度1例,术后5个月内置物激惹1例,两组间在并发症发生例数上无显著差异(P> 0.05),但渐变螺距螺钉组并发症发生例数相对较少;③结果证实,在内踝骨折的临床治疗中,应用分段渐变螺距中空埋头加压螺钉和普通空心半螺纹加压螺钉治疗的临床效果相当,但分段渐变螺距中空埋头加压螺钉可适当减少并发症的发生。

BACKGROUND:The headless reduction screw is an improved hollow screw.The clinical data are few compared with the common headless compression screws in the treatment of internal malleolus fracture.OBJECTIVE:To compare the postoperative effects of headless reduction screws and common headless compression screws in the treatment of medial malleolus fractures.METHODS:Totally 100 patients with medial malleolus fracture at the Department of Orthopedics,Affiliated Hospital to Chengdu University from July 2016 to October 2018 were retrospectively analyzed.Patients in the headless reduction screw group(n=50)were treated with headless reduction screw for internal fixation.Patients in the common headless compression screw group(n=50)were treated with common headless compression screws.Ankle radiographic examination was performed in each group after surgery to assess fracture healing time,complications,and AOFAS score.RESULTS AND CONCLUSION:(1)There was no significant difference in fracture healing time and AOFAS score between the two groups 6 weeks to 18 months after surgery(P>0.05).(2)Analysis of complications:delayed healing appeared in one case 7 months after operation,and internal fixation fracture in one case 12 months after operation in the headless reduction screw group.Wound infection appeared in one patient 2 days after operation,vein thrombosis in one patient 3 months after operation,delayed healing in two patients 6 and 9 months after operation,overpressure in one patient 1 day after operation,and internal irritation in one patient 5 months after operation in the common headless compression screw group.There was no statistical difference in the number of complications between the two groups(P>0.05).The number of complications was less in the headless reduction screw group than in the common headless compression screw group.(3)These results conclude that the clinical effect of applying headless reduction screw is similar to that of common headless compression screw group in the treatment of medial malleolus fracture.Headless reduction screws can reduce the complications properly.