踝关节骨折内固定术后负重时机的临床研究

Clinical study on weight-bearing time after internal fixation of ankle fracture

目的探讨踝关节骨折内固定术后负重时机的选择及不同时期负重的临床效果。方法纳入2020年10月-2021年3月于苏州大学附属独墅湖医院行常规内固定手术的踝关节骨折患者48例,随机分为试验组24例和对照组24例,试验组术后1周负重,对照组术后4周负重;分别在术后2、4、8、12周时对两组患者根据改良Weber量表进行评价,量表评分采用中位数(下四分位数,上四分位数)表示。结果两组患者骨折愈合良好,无并发症发生。术后2周时,试验组与对照组疼痛评分[3.00(2.00,3.00)vs.2.00(1.00,2.00)分]与肿胀评分[3.00(3.00,4.00)vs.2.00(1.00,2.00)分]差异有统计学意义(P<0.05),其余指标差异无统计学意义(P>0.05);术后4周时,试验组与对照组肿胀评分差异有统计学意义[2.00(2.00,3.00)vs.1.00(0.00,1.00)分,P<0.05],其余指标差异无统计学意义(P>0.05);术后8和12周时,两组各指标比较,差异均无统计学意义(P>0.05)。结论踝关节骨折术后早期负重是可行的,虽然会出现肿胀和疼痛情况,但并不影响骨折愈合和功能恢复。

Objective To explore the choice of weight-bearing time and the clinical effect of different starting time of weight bearing after internal fixation of ankle fracture.Methods A total of 48 patients undergoing routine internal fixation for closed ankle fractures were selected.They were randomly divided into a tiral group and a control group,with 24 patients in each group.The patients in the tiral group started weight bearing one week after operation,while the ones in the control group did that four weeks after operation.The two groups were followed up for evaluation according to the modified Weber scale 2,4,8,and 12 weeks after operation,and the scale scores were presented as median(lower quartile,upper quartile).Results The fractures recovered well and no complications occurred.Two weeks after operation,the pain score[3.00(2.00,3.00)vs.2.00(1.00,2.00)]and swelling score[3.00(3.00,4.00)vs.2.00(1.00,2.00)]were significantly different between the trial group and the control group(P<0.05),but there was no significant difference in other indexes of the modified Weber scale between the two groups(P>0.05).Four weeks after operation,the swelling score was significantly different between the two groups[2.00(2.00,3.00)vs.1.00(0.00,1.00),P<0.05],but there was no significant difference in other indexes of the modified Weber scale between the two groups(P>0.05).Eight and twelve weeks after operation,there was no significant difference in any of the modified Weber scale scores between the two groups(P>0.05).Conclusions It is feasible to start weight bearing one week after internal fixation of ankle fracture.Although swelling and pain will occur,it does not affect fracture healing or functional recovery.