不同入路内固定术治疗旋后外旋型Ⅳ度踝关节骨折的效果

Efficacies of Different Approaches of Internal Fixation in Treatment of Patients with Supination-external Rotation TypeⅣAnkle Fractures

目的探讨不同入路内固定术治疗旋后外旋型Ⅳ度踝关节骨折(AF)的效果。方法选取2018年2月—2020年9月收治的旋后外旋型Ⅳ度AF 120例,据手术入路的不同分为经腓骨后外侧入路(TPA)组61例和经腓骨入路(TA)组62例。比较两组手术相关指标、术后6个月骨折愈合情况(依据Lane-sandhu骨痂生长评分)、踝功能恢复情况[依据美国矫形外科足踝协会足功能评分系统(AOFAS)评分]及并发症发生情况。结果TPA组术中出血量少于TA组,手术时间、住院时间、骨折愈合时间短于TA组(P<0.01)。TPA组骨折愈合优良率及AOFAS评分优良率均明显高于TA组(P<0.05)。TPA组术后并发症总发生率明显低于TA组(P<0.05)。结论与TA内固定术比较,TPA内固定术治疗旋后外旋型Ⅳ度AF效果更佳,有利于减少手术创伤、缩短手术时间、促进骨折愈合和踝功能恢复,且安全性高。

Objective To investigate efficacies of different approaches of internal fixation in treatment of patients with supination-external rotation typeⅣankle fracture(AF).Methods A total of 120 patients with supination-external rotation typeⅣAF admitted between February 2018 and September 2020 were selected and divided into transfibular posterolateral approach(TPA)group(n=61)and transfibular approach(TA)group(n=62)according to different surgical approaches.The operation-related indicators,conditions of fracture healing(according to the Lane-sandhu callus growth score),conditions of ankle function recovery[according to the American Orthopaedic Foot and Ankle Society Foot Function Scoring System(AOFAS)score]and incidence rate of complications after operation for 6 months were compared between two groups.Results In TPA group,intraoperative volume of blood loss was less,and operative duration,length of hospitalization and fracture healing time were shorter than those in TA group(P<0.01).The excellent and good rates of fracture healing and AOFAS score in TPA group were significantly higher than those in TA group(P<0.05).The total incidence rate of postoperative complications in TPA group was significantly lower than that in TA group(P<0.05).Conclusion Compared with those by TA internal fixation,TPA internal fixation is more effective in treatment of patients with supination-external rotation typeⅣAF,which is conductive to reducing surgical trauma,shortening operative duration,and promoting fracture healing and ankle function recovery with good safety.