手法复位经皮穿针内固定结合石膏外固定治疗旋后外旋型Ⅱ度踝关节骨折的临床研究

A clinical study of manipulative reduction and percutaneous Kirschner wire internal fixation combined with plaster external fixation for treatment of supination-extorsion-type gradeⅡankle fractures

目的:探讨手法复位经皮穿针内固定结合石膏外固定治疗旋后外旋型Ⅱ度踝关节骨折的临床疗效和安全性。方法:回顾性分析2013年3月至2019年1月收治的108例旋后外旋型Ⅱ度踝关节骨折患者的病例资料。根据治疗方法分组,手法复位后采用克氏针经皮穿针内固定结合石膏外固定治疗者分入联合固定组,手法复位后单纯采用石膏外固定治疗者分入石膏外固定组,两组各54例。比较两组患者的骨折愈合时间、术后6周采用Leeds影像学评价标准评价的骨折复位情况、术后1年采用Baird踝关节评分系统评价的踝关节功能以及并发症发生情况。结果:108例患者均获随访,随访时间12~14个月,中位数12.5个月。术后6周,联合固定组骨折复位优良50例、可4例,石膏外固定组骨折复位优良38例、可13例、差3例;联合固定组骨折复位情况优于石膏外固定组(Z=-3.006,P=0.003)。骨折均愈合,2组患者骨折愈合时间比较,差异无统计学意义[(8.47±1.59)周,(8.52±1.62)周,t=1.496,P=0.175]。术后1年,联合固定组Baird踝关节评分高于石膏外固定组[(93.51±5.18)分,(84.18±4.32)分;t=8.483,P=0.011)。联合固定组术后3周时出现针孔感染1例,经换药治疗1周后感染控制;联合固定组6例患者和石膏外固定组9例患者术后1年踝关节僵硬、疼痛;均无二次骨折、骨折再移位等并发症发生;2组患者并发症发生率比较,差异无统计学意义(χ2=0.290,P=0.588)。结论:对于旋后外旋型Ⅱ度踝关节骨折,手法复位后采用克氏针经皮穿针内固定结合石膏外固定较单纯采用石膏外固定,骨折复位好、更有利于踝关节功能恢复,但二者在骨折愈合时间和并发症发生率方面无明显差异。

Objective:To explore the clinical curative effects and safety of manipulative reduction and percutaneous Kirschner wire internal fixation combined with plaster external fixation for treatment of supination-extorsion-type gradeⅡankle fractures.Methods:The medical records of 108 patients with supination-extorsion-type gradeⅡankle fractures recruited from March 2013 to January 2019 were analyzed retrospectively.The patients were divided into combination fixation group and plaster external fixation group according to the treatment methods, 54 cases in each group.All patients in the 2 groups were treated with manipulative reduction;moreover, the patients in combination fixation group were treated with percutaneous Kirschner wire internal fixation and plaster external fixation, and the patients in plaster external fixation group were treated with plaster external fixation.The fracture healing time, fracture reduction result evaluated by using Leeds imaging evaluation standard at 6 weeks after the surgery, ankle function evaluated by using Baird ankle scoring system at 1 year after the surgery and complication incidence were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 12-14 months with a median of 12.5 months.The results of fracture reduction evaluated at 6 weeks after the surgery showed that 50 patients obtained a good result and 4 fair in combination fixation group;while 38 patients obtained a good result, 13 fair and 3 poor in plaster external fixation group.The results of fracture reduction were better in combination fixation group compared to plaster external fixation group(Z=-3.006,P=0.003).All fractures healed in the 2 groups, and there was no statistical difference in the fracture healing time between the 2 groups(8.47±1.59 vs 8.52±1.62 weeks, t=1.496,P=0.175).The Baird ankle scores were higher in combination fixation group compared to plaster external fixation group at 1 year after the surgery(93.51±5.18 vs 84.18±4.32 points, t=8.483,P=0.011).The pinhole infections(1 case)were found in combination fixation group at 3 weeks after the surgery, and the infections were controlled after 1-week treatment with dressing change.Ankle ankylosis and pain were found in 6 patients in combined fixation group and 9 patients in plaster external fixation group at 1 year after the surgery.No complications such as refractures and fracture re-displacements were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups( χ2= 0. 290,P = 0. 588). Conclusion: After manipulative reduction,the combination therapy of percutaneous Kirschner wire internal fixation and plaster external fixation is more conducive to the ankle fracture reduction and ankle function recovery compared to the monotherapy of plaster external fixation in treatment of supination-extorsion-type grade Ⅱankle fractures. However,there is no obvious difference in fracture healing time and complication incidence between the two therapies.