前侧与外侧锁定钢板内固定踝关节融合术对创伤性踝关节骨性关节炎患者踝关节功能、IL-1β、IGF-1水平的影响

Effects of ankle fusion surgery with anterior and lateral locking plate internal fixation on ankle function,IL-1β and IGF-1 levels in patients with post-traumatic ankle osteoarthritis

目的探讨前侧与外侧锁定钢板内固定踝关节融合术对创伤性踝关节骨性关节炎患者踝关节功能、白细胞介素-1β(IL-1β)、促生长因子(IGF-1)水平的影响。方法选取2016年1月至2017年8月收治的90例创伤性踝关节骨性关节炎患者为研究对象,按照治疗方式的不同将其分为对照组和观察组,各45例。对照组于外侧行锁定钢板内固定踝关节融合术,观察组于前侧行锁定钢板内固定踝关节融合术。比较两组的手术情况、骨折愈合时间、创伤应激反应指标、踝关节功能及IL-1β、IGF-1水平。结果观察组的手术时间、切口长度、骨折愈合时间短于对照组,术后引流量少于对照组(P<0.05)。术后1周,两组的SP、5-HT及PGE;水平均较术前明显降低,且观察组低于对照组(P<0.05)。术后1、3、6个月,观察组的AOFAS评分高于对照组(P<0.05);术后12个月,两组的AOFAS评分无明显差异(P>0.05)。术后1个月,两组的IL-1β、IGF-1水平均较术前降低,且观察组低于对照组(P<0.05)。结论采用前侧或外侧锁定钢板内固定踝关节融合术治疗创伤性踝关节骨性关节炎均能取得较好的临床效果,但前侧入路能显著缩短手术时间,减小切口,减少术后引流量,减轻创伤应激反应,加快患者骨折愈合和踝关节功能恢复,同时可降低血清IL-1β、IGF-1水平,值得推广。

Objective To explore the effects of ankle fusion surgery with anterior and lateral locking plate internal fixation on ankle function,interleukin-1β(IL-1β) and growth-promoting factor(IGF-1) levels in patients with posttraumatic ankle osteoarthritis.Methods A total of 90 patients with post-traumatic ankle osteoarthritis admitted from January 2016 to August 2017 were selected as the study objects and divided into control group and observation group according to the different treatment methods,with 45 cases in each group.The control group underwent ankle fusion surgery with lateral locking plate internal fixation,and the observation group underwent ankle fusion surgery with anterior locking plate internal fixation.The operation,fracture healing time,trauma stress response indexes,ankle function and IL-1β and IGF-1 levels were compared between the two groups.Results The operation time,incision length and fracture healing time of the observation group were shorter than those of the control group,and the postoperative drainage volume was less than that of the control group(P<0.05).At 1 week after operation,the levels of SP,5-HT and PGE2 in the two groups were significantly lower than those before operation,and those in the observation group were lower than the control group(P<0.05).At 1,3 and 6 months after operation,the AOFAS score in the observation group was higher than that in the control group(P<0.05);at 12 months after operation,there was no significant difference in AOFAS score between the two groups(P>0.05).At 1 month after operation,the levels of IL-1β and IGF-1 in the two groups were lower than those before operation,and those in the observation group were lower than the control group(P <0.05).Conclusion Ankle fusion surgery with anterior or lateral locking plate internal fixation in the treatment of post-traumatic ankle osteoarthritis can achieve good clinical effects,but the anterior approach can significantly shorten the operation time,reduce the incision,postoperative drainage volume,alleviate traumatic stress response,accelerate the fracture healing and the recovery of ankle function,and reduce serum IL-1β and IGF-1 levels,which is worthy of promotion.