不同Weber-Denis型踝关节骨折治疗方式选择及远期疗效分析

Different Treatment Options for Weber-Denis Ankle Fractures and Analysis of Long-term Results

目的:探讨手法复位与切开复位内固定手术治疗不同类型踝关节骨折的远期临床疗效。方法:回顾分析2016年2月~2019年1月本院随访资料完整的踝关节骨折患者81例,其中手法复位石膏托固定患者36例(手法组),手术切开复位内固定患者45例(手术组)。根据Mazur制定的踝关节症状与功能评分标准对两组患者术后12个月踝关节功能进行评分,比较两种治疗方法的远期临床疗效有无差别。结果:Weber-Denis A型28例,手法组13例,复位成功12例,成功率为92.3%,术后12个月踝关节功能优良8例,优良率为66.7%(8/12);手术组15例,术后12个月踝关节功能优良14例,优良率为93.3%(14/15),两组术后12个月踝关节优良率比较差别无统计学意义(χ^2=1.77,P=0.08);Weber-Denis B型28例,手法组15例,复位成功13例,成功率为86.7%,术后12个月踝关节功能优良10例,优良率为76.9%(10/13);手术组13例,术后12个月踝关节功能优良12例,优良率为85.7%(12/13),两组术后12个月踝关节优良率比较差别无统计学意义(χ^2=1.09,P=0.28);Weber-Denis C型25例,手法组8例,复位成功3例,成功率为37.5%,术后12个月踝关节功能优良0例,优良率为0(0/3);手术组17例,术后12个月踝关节功能优良11例,优良率为64.7%(11/17),两组术后12个月踝关节优良率比较差别有统计学意义(χ^2=4.31,P=0.04)。结论:Weber-Denis A和B型踝关节骨折手术组患者手术与手法复位治疗后远期关节功能无明显差异,但Webe-Denis C型踝关节骨折手法复位后关节优良率较低,该型骨折患者应积极手术治疗。

Objective:To investigate the long-term clinical effect of manipulation vs operation for ankle fractures.Methods:A retrospective analysis of 81 patients with ankle fractures with complete follow-up data in our hospital from February 2016 to January 2019,including 36 patients with manual reduction and plaster fixation(manual group),and 45 patients with open reduction and internal fixation(surgery group).According to the ankle joint symptom and function scoring standard established by Mazur,the two groups of patients were scored on the ankle joint function at 12 months after the operation,and the long-term clinical efficacy of the two treatment methods was compared.Results:Results:28 cases of Weber-Denis type A,13 cases in the manual group,12 cases were successfully repositioned,the success rate was 92.3%,8 cases had excellent ankle function at 12 months after operation,the excellent rate was 66.7%(8/12);In the group of 15 cases,14 cases had excellent ankle function at 12 months after operation,the excellent and good rate was 93.3%(14/15).There was no significant difference in the excellent and good rate of ankle joint between the two groups at 12 months after operation(χ^2=1.77,P=0.08);28 cases of Weber-Denis type B,15 cases of manual group,13 cases of successful reduction,success rate of 86.7%,10 cases of excellent ankle function at 12 months after operation,excellent rate of 76.9%(10/13)There were 13 cases in the operation group,and 12 cases had excellent ankle function at 12 months after operation,with an excellent and good rate of 85.7%(12/13).There was no significant difference in the excellent and good rate of ankle joint between the two groups at 12 months after operation(χ^2=1.09,P=0.28);25 cases of Weber-Denis C type,8 cases in the manual group,3 cases were successfully reduced,the success rate was 37.5%,and 0 cases had excellent ankle function after 12 months,and the excellent rate was 0(0/3);There were 17 cases in the operation group,11 cases had excellent ankle function at 12 months after operation,the excellent and good rate was 64.7%(11/17),the difference between the two groups in the excellent and good rate of ankle joint at 12 months after operation was statistically significant(χ^2=4.31,P=0.04).Conclusion:There is no significant difference in longterm joint function between Weber-Denis type A and B ankle fracture surgery groups after surgery and manual reduction treatment,but Webe-Denis C type ankle fractures have a lower joint excellent rate after manual reduction.Patients should be actively treated with surgery.