后内外侧联合入路下3种内固定方式治疗后踝骨折的疗效比较

Efficacy comparision of three kinds of internal fixation methods for treatment of the posterior malleolar fractures via posterior medial-lateral combined approaches

目的比较后内外侧联合入路下3种内固定方式治疗后踝骨折的疗效。方法将45例HaraguchiⅡ型后踝骨折患者在后内外侧联合入路下按内固定方法不同分为空心钉组(15例)、单支撑钢板组(16例)和双支撑钢板组(14例)。比较3组手术情况、骨折复位质量、术后并发症发生情况、开始完全负重时间、骨折愈合时间、末次随访时踝关节活动度及AOFAS踝-后足评分。结果患者均获得随访,时间12~14个月。手术时间、术中出血量、骨折复位质量、住院时间、术后并发症发生率以及末次随访时踝关节活动度3组比较差异均无统计学意义(P>0.05);开始完全负重时间、骨折愈合时间以及末次随访时AOFAS踝-后足评分双支撑钢板组明显优于单支撑钢板组及空心钉组(P<0.05)。结论后内外侧联合入路下采用双支撑钢板内固定治疗后踝骨折具有固定牢固、骨折愈合快、患者可早期功能锻炼的优点,与单支撑钢板及空心钉内固定相比具有更高的临床应用价值。

Objective To compare the effect of three kinds of internal fixation for treatment of the posterior malleolar fractures via posterior medial-lateral combined approaches.Methods Forty-five patients with Haraguchi typeⅡposterior malleolar fractures were divided into cannulated screw group(15 cases),single support plate group(16 cases)and double support plates group(14 cases)via posterior medial-lateral combined approaches,according to the different fixation method.The following data were compared among the three groups,including the operation data,the fracutre reduction quality,the complications incidence situation,the start time of full-loading,the fracture healing time,the ankle range of motion and AOFAS ankle-hindfoot score at the last follow-up.Results All patients were followed up for 12~14 months.There were no statistically significant differences among the three groups in operation time,intraoperative blood loss,fracture reduction quality,hospital stay time,postoperative complication incidence rate,and ankle range of motion at the last follow-up(P>0.05).The double support plates group was significantly better than the single support plate group and cannulated group in the start time of full-loading,fracture healing time,and the AOFAS ankle-hindfoot score at the last follow-up(P<0.05).Conclusions For the posterior malleolar fracture,compared with single support plate and cannulated screw internal fixation,the double support plates has the advantage of firm fixation and fast fracture healing,and the patient can do early functional exercise,the double support plates has better clinical application value.