弹簧钩钢板在踝关节骨折及粉碎性踝关节后方结构损伤内固定中的应用

Application of spring hook plate in internal fixation of ankle fracture and comminuted posterior structural injury of ankle

目的探究弹簧钩钢板在骨质疏松性踝关节骨折及粉碎性踝关节后方结构损伤治疗中的应用效果。方法选取我院102例骨质疏松性踝关节骨折及粉碎性踝关节后方结构损伤患者,采用随机数字表法分为观察组和对照组,每组51例。2组患者均行切开复位内固定治疗,对照组采用空心螺钉固定后踝骨块,观察组采用弹簧钩钢板固定后踝骨块。比较2组患者手术情况、术后康复情况、骨痂评分、骨代谢指标[Ⅰ型前胶原氨基端前肽(PI-NP)、转化生长因子-β1(TGF-β1)、骨形态发生蛋白-2(BMP-2)]、踝关节功能恢复情况以及并发症发生情况。结果观察组术后引流量少于对照组,住院时间、骨折愈合时间均短于对照组(P<0.05);观察组术后1个月、2个月、3个月的骨痂评分均高于对照组(P<0.05);观察组术后3个月血清PI-NP、TGF-β1、BMP-2水平均高于对照组(P<0.05);观察组术后6个月踝关节功能优良率高于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05)。结论在骨质疏松性踝关节骨折及粉碎性踝关节后方结构损伤的切开复位内固定治疗中,采用弹簧钩钢板固定后踝骨块能促进患者术后康复,改善术后骨代谢,促进骨折愈合,减少并发症的发生,进一步提高踝关节功能。

Objective To explore the application effect of spring hook plate in the treatment of osteoporotic ankle fracture and comminuted posterior structural injury of ankle.Methods A total of 102 patients with osteoporotic ankle fracture and comminuted posterior structural injury of ankle in our hospital were selected and divided into the observation group and the control group according to random number table method,with 51 cases in each group.Patients in both groups were treated with open reduction and internal fixation,the control group was treated with cannulated screw to fix the posterior malleolus fragment,and the observation group was treated with a spring hook plate to fix the posterior malleolus block.The operation condition,postoperative rehabilitation,callus score,and bone metabolism indexes[N-terminal propeptide of typeⅠprecollagen(PINP),transforming growth factor-β1(TGF-β1),bone morphogenetic proteins-2(BMP-2)],ankle function recovery and incidence of complication of the two groups were compared.Results The postoperative drainage volume of the observation group was less than that of the control group(P<0.05),and the hospitalization time and fracture healing time were shorter than those of the control group(P<0.05).The callus scores 1 month,2 months and 3 months after operation in the observation group were higher than those in the control group(P<0.05).The levels of serum PI-NP,TGF-β1 and BMP-23 months after operation in the observation group were higher than those in the control group(P<0.05).The excellent and good rate of ankle function 6 months after operation in the observation group was higher than that in the control group(P<0.05).The total incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion In the open reduction and internal fixation treatment of osteoporotic ankle fracture and comminuted posterior structural injury of ankle,the use of spring hook plate to fix the posterior malleolus fragment can promote postoperative rehabilitation of patients,improve postoperative bone metabolism,promote fracture healing,reduce complications,and further improve ankle function.