后踝骨折手术治疗中经皮螺钉固定与锁定钢板固定的应用对比研究

Comparative study of percutaneous screw fixation and locking plate fixation in surgical treatment of posterior malleolus fracture

目的 比较空心螺钉和锁定钢板在后踝骨折手术治疗中的临床价值。方法 选择蚌埠医学院附属连云港市第二人民医院创伤骨科2015年4月至2020年4月收治的100例踝关节骨折患者,均为骨折累及后踝关节面25%以上,按照手术方法不同分为钢板组与螺钉组,每组50例,钢板组患者后踝骨折采用踝关节后外侧入路锁定钢板固定,螺钉组采用撬拨复位后空心螺钉固定,螺钉置入方向包括前后两个方向置入,记录并比较两组患者的手术时间、手术失血量及术后并发症,所有患者均至少随访12个月,随访期间采用美国足踝外科协会(the American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分评价踝关节功能,并评价患者的关节活动度。结果 螺钉组8例患者术中撬拨复位欠佳,改为踝关节后外侧入路切开螺钉固定;钢板组患者平均手术时间为(1.52±0.31)h,螺钉组患者平均手术时间为(1.47±0.45)h,两组差异无统计学意义(P> 0.05);钢板组患者术中出血量为(381.52±122.37)ml,螺钉组患者术中出血量为(269.56±95.53)ml,钢板组患者手术平均出血量高于螺钉组,差异有统计学意义(P <0.05)。螺钉组患者平均住院时间为(5.27±1.71)d,钢板组患者平均住院时间为(5.41±1.65)d,两组差异无统计学意义(P> 0.05);螺钉组和钢板组发生伤口感染分别为1例和3例,复位丢失分别为2例和1例,未发生骨折不愈合,差异无统计学意义(P> 0.05)。钢板组及螺钉组术后6个月的AOFAS评分分别为(85.70±7.35)分、(87.12±6.36)分,差异无统计学意义(P> 0.05);钢板组及螺钉组术后12个月的AOFAS分别为(92.45±6.62)分、(91.18±5.69)分,差异无统计学意义(P> 0.05);两组患者术后12个月随访时踝关节各项活动度(背伸、跖屈、内翻、外翻)比较差异无统计学意义(P> 0.05)。结论 踝关节骨折中后踝骨折的固定采用钢板及螺钉均可取得良好的临床疗效,经皮螺钉固定创伤小,但存在部分患者复位欠佳、需切开复位;而锁定钢板直视下复位,固定牢靠、但创伤较大,临床应根据患者病情及身体状况酌情选择。

Objective To compare the clinical value of locking plate and hollow screw in the surgical treatment of posterior malleolus fracture. Methods Total of 100 patients with ankle fracture were admitted to the department of trauma and orthopedics of Lianyungang Second People’s Hospital affiliated to Bengbu Medical College from April 2015 to April 2020, all of whom had fracture involving more than 25% of the posterior ankle surface were divided into plate group and screw group according to different surgical methods, with 50 patients in each group. The posterior ankle fracture of patients in the plate group were fixed with locking plate through a posterolateral approach of the ankle joint, and the screw group were fixed with hollow screw after reduction by pry, and the screw placement direction included the anterior and posterior directions. The operation time, operative blood loss and postoperative complications of patients in the two groups were recorded and compared. All patients were followed up for at least 12 months. Ankle function and range of motion were evaluated by the American Orthopaedio Foot and Ankle Society(AOFAS) during follow-up. Results In the screw group, 8 patients were replaced by posterior lateral approach screw fixation. The average operation time of patients in the plate group were(1.52±0.31) h, and those of patients in the screw group were(1.47±0.45) h, and there was no significant difference between the two groups(P > 0.05). Intraoperative blood loss were(381.52±122.37) ml in the plate group and(269.56±95.53) ml in the screw group, and the average amount of blood loss in the plate group were higher than those in the screw group, with statistical significance(P < 0.05). The mean length of hospital stay in the screw group were(5.27±1.71) d, and those in the steel plate group were(5.41±1.65) d, and there was no significant difference between the two groups(P > 0.05). There were 1 case of wound infection and 2 cases of loss of reduction in the screw group, 3 cases of wound infection and 1 case of loss of reduction in the plate group. No fracture nonunion in both of the two groups. AOFAS scores of the plate group and the screw group were(85.70±7.35) points and(87.12±6.36) points at 6 months after operation, respectively, and there was no statistical significance(P > 0.05). AOFAS of the plate group and the screw group were(92.45±6.62) points and(91.18±5.69) points at 12 months after operation, and there was no statistical significance(P > 0.05).There was no significant difference in ankle motion(dorsiflexion, plantarflexion, varus and valgus) between the two groups at 12 months follow-up(P > 0.05). Conclusion After ankle fracture in ankle fractures fixed by plates and screws can achieve good clinical curative effect of percutaneous screw fixation trauma is small, but there are some patients poor reset to open reduction, locking plate under the direct reduction, fixation, but large trauma, clinical should choose according to patients condition and physical condition as appropriate.