分期切开复位内固定与一期手术治疗踝关节骨折的临床观察

Clinical observation of staged open reduction and internal fixation and one-stage surgery for ankle fractures

目的 比较分期切开复位内固定治疗与一期手术治疗踝关节骨折的临床效果。方法 以2018年1月至2021年2月泗洪医院收治的81例踝关节骨折患者为对象开展研究,按照患者接受治疗的术式不同将其分为两组,一期组(40例)接受一期切开复位内固定治疗,分期组(41例)接受分期切开复位内固定治疗,比较两组的固定优良率、肿胀消除时间、住院时间、骨折愈合时间、踝关节活动度。结果 分期组治疗后的固定优良率为87.80%,高于一期组的70.00%(x^(2)=3.871,P=0.049);分期组治疗后的肿胀消除时间、住院时间、骨折愈合时间为(8.45±3.92)d、(2.16±1.72)周、(10.13±3.86)周,均短于一期组[(13.76±5.17)d、(3.84±1.79)周、(14.85±5.19)周,t=5.217、4.308、4.652,P <0.05];分期组术后6个月的跖屈、背屈角度为(17.16°±3.23°)、(23.76°±3.82°),均大于一期组[(13.21°±2.18°)、(28.37°±4.13°),P <0.05],分期组外翻、内翻角度为(0.41°±0.23°)、(0.62°±0.32°),均小于一期组[(1.37°±0.48°)、(1.89°±0.30°),P <0.05)]。结论 相较于接受一期切开复位内固定治疗,踝关节骨折患者接受分期切开复位内固定治疗,可获得更好的恢复效果,能更显著的改善踝关节活动度。

Objective To compare the clinical effects of staged open reduction and internal fixation and one-stage surgery for ankle fractures. Methods A study was carried out on 81 patients with ankle fractures admitted to Sihong Hospital from January 2018 to February 2021. The patients were divided into two groups according to the different surgical procedures. One-stage group(40 cases)received one-stage open reduction and internal fixation, and the staged group(41 cases) received staged open reduction and internal fixation. The excellent and good rate of fixation, swelling elimination time, hospital stay, fracture healing time, and ankle range of motion were compared between the two groups. Results The excellent and good rate of fixation in the staged group after treatment were 87.80%,which were higher than 70.00% in the one-stage group(x^(2)=3.871, P=0.049). The swelling elimination time, hospitalization time and fracture healing time after treatment in the staged group were(8.45±3.92) d,(2.16±1.72) weeks,(10.13±3.86) weeks, all shorter than the one-stage group [(13.76±5.17) d,(3.84±1.79) weeks,(14.85±5.19) weeks, t=5.217, 4.308, 4.652, P < 0.05]. The plantar flexion and dorsiflexion angles of the staged group at 6 months after operation were(17.16 ° ±3.23 °),(23.76 ° ±3.82 °), which were greater than those of the one-stage group [(13.21° ±2.18°),(28.37° ±4.13°), P < 0.05];the valgus and varus angles of the stage group were(0.41° ±0.23°),(0.62° ±0.32°), which were less than the one-stage group [(1.37° ±0.48°),(1.89° ±0.30°),P < 0.05)]. Conclusion Compared with one-stage open reduction and internal fixation, patients with ankle fractures who receive staged open reduction and internal fixation can achieve better recovery effect and significantly improve the range of motion of the ankle joint.