空心螺钉和T形解剖钢板内固定治疗后踝骨折的临床效果比较

Comparison of clinical effects of internal fixation with hollow screw and T-shaped anatomical plate in the treatment of posterior malleolus fracture

目的比较空心螺钉和T形解剖钢板内固定治疗后踝骨折的临床效果。方法选取2018年1月至2021年8月无锡市中医医院创伤骨科100例诊断为踝关节骨折的患者作为研究对象,根据后踝骨折固定方法不同将其分为空心螺钉组和T形解剖钢板组,每组50例。空心螺钉组行空心螺钉内固定,T形解剖钢板组行T形解剖钢板内固定。比较两组的手术及恢复情况相关指标、并发症发生情况、踝关节功能恢复情况及疼痛程度。结果T形解剖钢板组的手术时间明显长于空心螺钉组,术中失血量明显多于空心螺钉组,骨折愈合时间显著短于空心螺钉组(P<0.05);两组的伤口拆线时间、住院天数比较,差异无统计学意义(P>0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。术后3个月,两组的美国足踝外科医生协会评分系统(AOFAS)、视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);术后6、12个月,T形解剖钢板组的AOFAS评分明显高于空心螺钉组(P<0.05);术后6个月,T形解剖钢板组的VAS评分明显低于空心螺钉组(P<0.05)。结论与空心螺钉内固定相比,T形解剖钢板内固定后踝生物力学强度更好、固定更坚强。但总体来说二者各有利弊,应互为补充。在临床应用中应综合判断、决定采取何种固定方式,以求更大限度地减少术后并发症的发生,恢复患者的踝关节功能。

Objective To compare the clinical effects of internal fixation with hollow screw and T-shaped anatomical plate in the treatment of posterior malleolus fracture.Methods A total of 100 patients with ankle fracture diagnosed in the orthopedics trauma department of Traditional Chinese Medicine Hospital of Wuxi City from January 2018 to August 2021 were selected as the research objects.According to the different fixation methods of posterior malleolus fracture,the patients were divided into hollow screw group and T-shaped anatomical plate group,with 50 cases in each group.The hollow screw group was treated with hollow screw internal fixation,and the T-shaped anatomical plate group was treated with T-shaped anatomical plate internal fixation.The operation and recovery related indexes,occurrence of complications,ankle function recovery and pain degree were compared between the two groups.Results The operation time of the T-shaped anatomical plate group was significantly longer than that of the hollow screw group,the intraoperative blood loss was significantly more than that of the hollow screw group,and the fracture healing time was significantly shorter than that of the hollow screw group(P<0.05);there were no significant differences in wound suture removal time and hospitalization time between the two groups(P>0.05).At 3 months after operation,there were no significant differences in American Orthopedic Foot and Ankle Society(AOFAS)and Visual Analogue Scale(VAS)scores between the two groups(P>0.05);at 6 and 12 months after operation,the AOFAS score of the T-shaped anatomical plate group was significantly higher than that of the hollow screw group(P<0.05);at 6 months after operation,the VAS score of the T-shaped anatomical plate group was significantly lower than that of the hollow screw group(P<0.05).Conclusion Compared with hollow screw internal fixation,T-shaped anatomical plate internal fixation has better biomechanical strength and stronger fixation.However,in general,both have their own advantages and disadvantages,and should complement each other.In clinical application,we should comprehensively judge and decide which fixation method to adopt,in order to reduce the occurrence of postoperative complications to a greater extent and restore the ankle function of patients.