改良1/3管形钢板与空心钉内固定治疗三踝骨折中后踝骨折的疗效比较

Comparison of modified 1/3 tubular plate and hollow screw internal fixation in treatment of posterior malleolus fractures of trimalleolar fractures

目的 比较三踝骨折切开复位内固定术中采用改良1/3管形钢板与空心钉固定后踝骨折块的临床效果。方法 回顾性分析自2017-04—2019-08采用切开复位内固定手术治疗的99例三踝骨折,其中47例后踝骨折采用空心钉内固定(空心钉组),52例后踝骨折采用改良1/3管形钢板内固定(改良钢板组)。比较两组手术时间、术中出血量、后踝骨折愈合时间,以及末次随访时踝与后足功能AOFAS评分。结果 99例均获得随访,随访时间平均16.3(6~27)个月。改良钢板组4例术后出现切口红肿,经抗生素及换药治疗后愈合。空心钉组与改良钢板组的手术时间、术中出血量差异无统计学意义(P>0.05)。改良钢板组后踝骨折愈合时间较空心钉组短,差异有统计学意义(P<0.05)。末次随访时空心钉组踝与后足功能AOFAS评分:优16例,良21例,可9例,差1例;改良钢板组踝与后足功能AOFAS评分:优26例,良23例,可3例;改良钢板组末次随访时AOFAS评分优于空心钉组,差异有统计学意义(P<0.05)。结论 踝关节骨折的治疗目的是解剖复位关节面并早期功能锻炼,采用改良1/3管形钢板可以有效固定后踝骨折块,患者可早期进行功能锻炼,促进后踝骨折愈合与踝关节功能恢复。

Objective To compare the clinical effect of modified 1/3 tubular plate and hollow screws for posterior malleolus fractures in open reduction and internal fixation of trimalleolar fractures. Methods A retrospective analysis was made on 99 cases of trimalleolar fractures treated with open reduction and internal fixation from April 2017 to August 2019. Among them, 47 cases of posterior malleolar fractures were treated with hollow screw internal fixation (hollow screw group) while 52 cases of posterior malleolar fractures were treated with modified 1/3 tubular plate internal fixation (modified plate group). The operation time, intraoperative blood loss, posterior malleolus fracture healing time and AOFAS score of ankle and hindfoot function at the last follow-up were compared between the two groups. Results All 99 cases were followed up for an average of 16.3 (6-27) months. In the modified plate group, the incision swelling occurred in 4 cases after operation and healed after treatment with antibiotics and wound dressing. There was no significant difference in operation time and intraoperative blood loss between hollow screw group and modified plate group (P>0.05). The fracture healing time of posterior malleolus in modified plate group was shorter than that in hollow screw group, and the difference was statistically significant (P<0.05). At the last follow-up, the functional AOFAS scores of ankle and hindfoot in the hollow screw group were excellent in 16 cases, good in 21 cases, fair in 9 cases and poor in 1 case, while in the modified plate group, the functional AOFAS scores of ankle and hindfoot were excellent in 26 cases, good in 23 cases and fair in 3 cases, and the AOFAS score in the modified plate group was better than that in the hollow screw group at the last follow-up, the difference was statistically significant (P<0.05). Conclusion The purpose of the treatment of ankle fractures is anatomical reduction of the articular surface and early functional exercise. The fracture block of the posterior malleolus can be effectively fixed with the modified 1/3 tubular plate, and the patients can carry out early functional exercise to promote the healing of the posterior malleolar fracture and the recovery of ankle function.