拉力螺钉治疗旋后外旋型踝关节骨折的临床研究

Clinical study of lag screw in the treatment of supination external rotation ankle fracture

目的探讨采用拉力螺钉治疗旋后外旋型踝关节骨折的临床效果。方法筛选2018年7月-2020年1月收治的116例旋后外旋型踝关节骨折患者,按照随机数字分配法分成观察组(n=48)和对照组(n=68)。观察组使用拉力螺钉手术治疗,对照组使用传统的正骨复位治疗,石膏固定。观察两组的住院天数及住院费用;治疗后踝关节的功能恢复情况及Mazur评分;4周、8周、10周的骨痂生长情况以及优良率。结果Ⅱ型骨折,观察组的Mazur评分(95.36±2.31)分与对照组(94.59±2.35)分比较差异无统计学意义(P>0.01),而Ⅲ型、Ⅳ型骨折观察组的Mazur评分(Ⅲ型91.69±1.98分、Ⅳ型89.57±2.50分)明显高于对照组(Ⅲ型88.41±2.04分、Ⅳ型84.33±3.19分)(P<0.01);治疗后4周、8周、10周的骨痂生长情况观察组明显好于对照组,差异具有统计学意义(P<0.01);观察组的优良率(97.9%)高于对照组(85.3%),差异有统计学意义(P<0.05);术后4周观察组VAS评分(3.46±1.32)分以及肿胀程度(0.75±0.08)均低于对照组,且差异具有统计学意义(P<0.01);观察组的住院天数(10.35±2.57)d长于对照组(5.42±1.56)d,骨折愈合时间(10.67±0.95)周短于对照组(12.89±1.35)周,差异具有统计学意义(P<0.01)。结论对于Ⅲ型、Ⅳ型旋后外旋型踝关节骨折拉力螺钉手术治疗效果远好于中医正骨治疗,但Ⅱ型骨折两种治疗效果相差无几。

Objective To study the clinical effect of lag screw in the treatment of supination external rotation ankle fracture.Methods A total of 116 patients with ankle fracture of supination external rotation admitted to Qingyuan Hospital of Traditional Chinese Medicine from July 2018 to January 2020 were selected and divided into observation group(n=48)and control group(n=68)according to different treatment methods.The observation group was treated with lag screw,and the control group was treated with traditional bone setting reduction and plaster fixation.The follouing indicator of the two groups after treatment was observed,including the length of hospitalization and the cost of hospitalization,the functional recovery of the ankle joint and Mazur score after treatment,the callus growth at 4,8 and 10 weeks,the good and good recovery rate of the two groups after treatment.Results Mazur score of(95.36±2.31)in the observation group was not significantly different from(94.59±2.35)in the control group with typeⅡfracture.The Mazur scores of patients with typeⅢand typeⅣfractures in the observation group(typeⅢ91.69±1.98,typeⅣ89.57±2.50)were significantly higher than those of the control group(typeⅢ88.41±2.04,typeⅣ84.33±3.19)(P<0.01).The callus growth of the observation group was significantly higher than that of the control group at 4,8 and 10 weeks after treatment(P<0.01).After treatment,the excellent and good rate of the observation group was 97.9%higher than that of the control group,which was 85.3%,and it was statistically significant(P<0.05).At 4 weeks after operation,the VAS score(3.46±1.32)and swelling degree(0.75±0.08)of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.01).The length of hospital stay in the observation group was(10.35±2.57)longer than that in the control group,and the fracture healing time was(10.67±0.95)shorter than that in the control group,and the differences were statistically significant(P<0.01).Conclusion The clinical effect of surgical treatment for typeⅢandⅣfractures is far better than that of traditional Chinese medicine(TCM)bone-setting treatment,and the curative effect of surgical treatment and TCM bone-setting treatment for typeⅡfractures was little difference.