关节镜下闭合复位经皮内固定对踝关节骨折术后AOFAS评分、骨代谢标志物及创伤反应的影响

Effects of arthroscopic-assisted closed reduction and percutaneous internal fixation on AOFAS score,bone metabolic markers and trauma response after ankle fracture surgery

目的探讨关节镜下闭合复位经皮内固定在踝关节骨折中应用效果及对患者术后美国足踝外科医生协会评分系统(American Orthopedic Foot and Ankle Society,AOFAS)评分、骨代谢标志物及创伤反应的影响。方法回顾性分析我院109例踝关节骨折患者临床资料,依据治疗术式不同分为关节镜组(n=55)、常规组(n=54)。常规组采取常规切开复位内固定,关节镜组采取关节镜下闭合复位经皮内固定。比较两组手术有关指标、术前、术后1 d、术后3 d创伤反应指标[C反应蛋白(C-reactive protein,CRP)、白细胞介素8(interleukin-8,IL-8)、皮质醇(cortisol,Cor)、去甲肾上腺素(norepinephrine,NE)]、术前、术后2周、4周骨代谢标志物[骨钙素(bone carboxyglutamic acid protein,BGP)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、β-胶原降解产物(β-collagen degradation products,β-CTX)]水平,并统计并发症发生情况、术前、术后3个月、6个月踝关节跖屈、背伸状态下肌力、关节主动活动度范围、AOFAS评分、生活质量综合评定问卷74(Generic Quality of Life Inventory-74,GQOL-74)。结果关节镜组术中出血量较常规组少,手术时间、住院时间、骨折愈合时间较常规组短(P<0.05);关节镜组术后1 d、3 d血清CRP、IL-8、Cor、NE与术后2周、4周血清β-CTX水平均低于常规组,术后2周、4周血清BGP、BALP水平均高于常规组(P<0.05);关节镜组术后并发症发生率3.64%低于常规组16.67%(P<0.05);关节镜组术后3个月、6个月踝关节跖屈、背伸状态下肌力、关节主动活动度范围与AOFAS、GQOL-74评分均高于常规组(P<0.05)。结论应用关节镜下闭合复位经皮内固定治疗踝关节骨折可降低手术创伤,促进术后恢复,减少并发症,改善骨代谢情况,提升踝关节功能与生活质量,临床应用价值较高。

Objective To investigate the effect of arthroscopic-assisted closed reduction and percutaneous internal fixation in ankle fracture and its effect on the postoperative American Orthopedic foot and Ankle Society(AOFAS)score,bone metabolic markers and trauma response.Methods The clinical data of 109 patients with ankle fracture in our hospital were analyzed retrospectively.According to different surgical methods,they were divided into arthroscopy group(n=55)and conventional group(n=54).The conventional group was given conventional open reduction and internal fixation,and the arthroscopic group was given arthroscopic-assisted closed reduction and percutaneous internal fixation.The operation-related indexes,trauma response indexes[C-reactive protein(CRP),interleukin-8(IL-8),cortisol(Cor),norepinephrine(NE)]before operation,and at 1 d and 3 d after operation,and the levels of bone metabolic markers[boneγ-carboxyglutamic acid-containing protein(BGP),bone alkaline phosphatase(BALP),β-collagen degradation products(β-CTX)]before operation,and at 2 weeks and 4 weeks after operation were compared between two groups.The incidence of complications,muscle strength of ankle plantar flexion and dorsiflexion,active range of motion(AROM),AOFAS score and Generic Quality of Life Inventory-74(GQOL-74)were calculated before operation,and at 3 months and 6 months after operation.Results The amount of intraoperative bleeding in arthroscopy group was lower than that in conventional group,and the duration of operation,length of hospital stay and fracture healing time were shorter than those in conventional group(P<0.05).The serum CRP,IL-8,Cor and NE at 1 d and 3 d after operation and serumβ-CTX level at 2 weeks and 4 weeks after operation were lower in arthroscopy group than in the conventional group,while the levels of serum BGP and BALP were higher than those in the conventional group at 2 and 4 weeks after operation(P<0.05).The incidence of postoperative complications in arthroscopy group was 3.64%,which was lower than that(16.67%)in conventional group(P<0.05).At 3 and 6 months after operation,the muscle strength of ankle plantar flexion and dorsiflexion,AROM and AOFAS and GQOL-74 scores in arthroscopy group were higher than those in conventional group(P<0.05).Conclusion Arthroscopic-assisted closed reduction and percutaneous internal fixation in the treatment of ankle fracture can reduce surgical trauma,promote postoperative recovery,reduce complications,improve bone metabolism,and improve ankle function and quality of life.Therefore,it is of high application value.