经后外侧入路钢板和螺钉内固定治疗后踝骨折疗效比较

Comparison of effectiveness between plate and screw internal fixation in treatment of posterior malleolus fractures through posterolateral approach

目的比较经后外侧入路钢板或螺钉内固定治疗后踝骨折的临床疗效。方法回顾分析2016年1月—2019年12月收治且符合选择标准的的95例后踝骨折患者临床资料,根据治疗方式不同分为钢板组(44例,采用后外侧入路钢板内固定治疗)和螺钉组(51例,采用后外侧入路螺钉内固定治疗)。两组患者年龄、性别、致伤原因、受伤侧别、踝关节骨折或损伤分型、受伤至手术时间及后踝骨折面积占胫骨远端关节面百分比等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、住院时间、骨折愈合时间及手术并发症;采用影像学检查(X线片、CT平扫及重建)判断踝关节骨折复位质量、关节面平整度及有无骨折再移位;末次随访时采用疼痛视觉模拟评分(VAS)评价患者疼痛情况,美国矫形足踝协会(AOFAS)踝-后足评分评价踝关节功能。结果两组患者均获随访,随访时间6~30个月,平均18.2个月。钢板组手术时间明显长于螺钉组(U=-2.040,P=0.041);两组住院时间比较差异无统计学意义(U=-1.068,P=0.285)。术后钢板组2例发生切口红肿、3例发生腓肠神经损伤、2例随访过程中发生创伤性关节炎,螺钉组分别为1、2、2例,两组并发症发生率(15.9%vs. 9.8%)比较差异无统计学意义(P=0.372)。行下胫腓螺钉固定者均于术后12周下肢完全负重前行下胫腓螺钉取出术,均未发生螺钉断裂滞留情况。随访期间两组均未出现感染、骨折再移位、骨延迟愈合或骨不连等情况,两组骨折愈合时间比较差异无统计学意义(t=0.345,P=0.731)。两组踝关节骨折复位质量及关节面平整度评价结果比较差异均无统计学意义(P>0.05)。末次随访时,两组VAS评分、AOFAS踝-后足评分及评价等级比较差异均无统计学意义(P>0.05)。结论经后外侧入路螺钉和钢板内固定治疗后踝骨折均可获得良好临床疗效,骨折复位维持效果理想,踝关节功能恢复佳。但前者具有微创、手术时间短的优势。

Objective To compare the effectiveness of posterior malleolus fractures treated by plate and screw internal fixation through posterolateral approach. Methods The clinical data of 95 patients with posterior malleolus fractures who were admitted between January 2016 and December 2019 and met the selection criteria were retrospectively analysed. They were divided into plate group(44 cases, treated with posterolateral plate internal fixation) and screw group(51 cases, treated with posterolateral screw internal fixation) according to different treatment methods. There was no significant difference in general data between the two groups of patients such as age, gender, cause of injury, side of injury,ankle fracture or injury classification, time from injury to operation, and percentage of posterior ankle fracture area to the distal tibia articular surface(P>0.05). The operation time, hospital stay, fracture healing time, and surgical complications were compared between the two groups. Imaging examinations(X-ray film, CT scan and reconstruction) were used to assess the reduction quality of ankle fracture, articular congruity, and re-displacement in ankle fracture. At last follow-up,the pain visual analogue scale(VAS) score was used to evaluate the patients’ pain, and the American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot score was used to evaluate ankle joint function. Results Patients in both groups were followed up 6-30 months, with an average of 18.2 months. The operation time of the plate group was significantly longer than that of the screw group(U=-2.040, P=0.041);there was no significant difference in hospital stay between the two groups(U=-1.068, P=0.285). Incision swelling occurred in 2 cases in the plate group, sural nerve injury in 3 cases, and traumatic arthritis in 2 cases during follow-up. In the screw group, there were 1, 2, and 2 cases, respectively.The incidence of complications in the two groups(15.9% vs. 9.8%) was not significantly different(P=0.372). All patients who underwent tibiofibular screw fixation underwent the removal of the tibiofibular screw before taking full weight bearing at 12 weeks after operation, and there was no screw fracture and retention. During the follow-up, there was no infection, re-displacement of fracture, delayed bone union or nonunion, and there was no significant difference in fracture healing time between the two groups(t=0.345, P=0.731). There was no significant difference between the two groups of reduction quality of ankle fracture and articular congruity evaluation results(P>0.05). At last follow-up, there was no significant difference in VAS score, AOFAS ankle-hindfoot score and evaluation grade between the two groups(P>0.05).Conclusion Both the plate and screw internal fixation through posterolateral approach can achieve satisfied effectiveness in the treatment of posterior ankle fractures with maintenance of fracture reduction, and recovery of ankle joint function.The screw internal fixation has the advantages of minimal invasion and shorter operation time.