踝关节外侧入路融合内固定方式治疗创伤性踝关节炎的效果分析

Comparison of the curative effects between locking compression plate fixation and fibular support compression screw internal fixation in ankle fusion via ankle joint lateral approach

目的比较观察外侧入路过程中使用锁定加压钢板固定与腓骨支撑加压螺钉内固定在踝关节融合术中的疗效。方法回顾性收集承德医学院附属医院2015年12月至2017年12月收治的踝关节创伤性关节炎患者44例,分为加压钢板组(n=23)与加压螺钉组(n=21),比较2组手术实施情况、术后并发症、术后疼痛情况采用国际通用VAS视觉模拟分析法(VAS)及术后12个月踝-足功能(AOFAS)恢复效果。结果全部患者获得随访,随访时间(12.0±1.2)个月。加压钢板组和加压螺钉组患者在手术时间[(62±3)min,(62±4)min]、切口长度[(11.30±1.60)cm,(11.82±1.26)cm]、术后引流量[(54.7±2.2)ml,(54.3±2.6)ml]及术后疼痛比较,差异均无统计学意义(P>0.05);加压钢板组骨愈合时间[(12.52±1.23)周]短于加压螺钉组[(13.42±1.50)周],差异有统计学意义(P<0.05);术后12个月,加压钢板组踝-足功能[(85.21±3.96)分]明显高于加压螺钉组[(82.10±3.14)分],差异有统计学意义(P<0.05);加压钢板和加压螺钉组并发症发生率分别为8.69%(2/23)、28.57%%(6/21),差异无统计学意义(P>0.05)。结论踝关节融合术使用锁定加压钢板进行内固定效果优于腓骨支撑螺钉内固定,骨愈合时间缩短,患者术后踝足功能恢复理想,安全可靠。

Objective To compare the curative effects between locking compression plate fixation and fibular support compression screw internal fixation in ankle fusion via ankle joint lateral approach.Methods A total of 44 patients with traumatic arthritis of ankle joint who were treated in our hospital from December 2015 to December 2017 were enrolled in the study,who were divided into compression plate group(n=23)and compression screw group(n=21).The operation implementation status,postoperative complications,and postoperative pain score(VAS)as well as the recovery effects of ankle-foot function(AOFAS)at 12m after operation were observed and cpmpared between the two groups.Results All the patients were followed up for(12±1.2)months.There were no significant differences in the operation time,incision length,postoperative drainage volume and postoperative pain scores between the two groups(P>0.05).However the bone healing time in compression plate group was significantly shorter than that in compression screw group(P<0.05),but,the ankle-foot function scores at 12m after surgery in compression plate group were significantly higher than those in compression screw group(P<0.05).There was no significant difference in the incidence rate of complications between the two groups(P>0.05).Conclusion The effects of internal fixation with locking compression plate for ankle fusion are superior to those by fibular support screw internal fixation in treatment of traumatic arthritis of ankle joint,and the bone healing time in the former is shorter,the postoperative ankle and foot function recovery is ideal,with safety and reliability.