经腓骨后外侧入路内固定术治疗旋后外旋型Ⅳ度踝关节骨折的效果

Effect of Internal Fixation via Transfibular Posterolateral Approach in the Treatment of Supination-external Rotation Type IV Ankle Fractures

目的:探讨经腓骨后外侧入路(TPA)内固定术治疗旋后外旋型Ⅳ度踝关节骨折(AF)的效果。方法:回顾性分析2018年1月-2022年3月乌鲁木齐市友谊医院收治的63例旋后外旋型Ⅳ度AF患者的资料,依照不同手术入路方式分为两组,即选择经腓骨入路(TA)内固定术的30例患者为TA组,另选择TPA内固定术的33例患者为TPA组。记录两组临床手术相关指标、总体疗效、术前及术后3个月的踝关节功能(Olerud-Molander功能评分和AOFAS踝-后足评分系统)、并发症发生情况及术前和术后3个月的骨代谢指标[血清骨钙素(BGP)、Ⅰ型前胶原羧基端肽(PⅠCP)、总Ⅰ型前胶原N端前肽(Total-PⅠNP)水平]。结果:TPA组的手术时间、术后住院时间、骨折愈合时间和完全负重时间均短于TA组,术中出血量少于TA组(P<0.05)。TPA组术后3个月后临床优良率高于TA组(87.88%vs 66.67%,P<0.05)。两组术后3个月的Olerud-Molander功能评分及AOFAS踝-后足评分均较术前高,TPA组均高于TA组(P<0.05)。TPA组的并发症发生率相比TA组低(3.03%vs 20.00%,P<0.05)。术后3个月,两组血清BGP、PⅠCP水平均较术前高,TPA组均高于TA组;两组血清Total-PⅠNP水平较术前低,TPA组低于TA组(P<0.05)。结论:相比TA内固定术,TPA内固定术能明显缩短旋后外旋型Ⅳ度AF患者的手术时间、住院时间、骨折愈合时间和完全负重时间,减少术中出血量,提高临床疗效,改善术后踝关节功能,并能减少并发症,促进骨代谢平衡。

Objective:To explore the effect of transfibular posterolateral approach(TPA)internal fixation in the treatment of supination-external rotation typeⅣankle fractures(AF).Method:The data of 63 patients with supination-external rotation typeⅣAF who were treated in Urumqi Friendship Hospital from January 2018 to March 2022 were retrospectively analyzed,and the patients were divided into two groups according to different surgical approaches.Among the patients,30 cases with internal fixation via transfibular approach(TA)were selected as TA group,and 33 cases with internal fixation via TPA were enrolled as TPA group.The clinical surgery-related indicators,overall efficacy,ankle function(Olerud-Molander function score,AOFAS ankle-hindfoot scoring system)before surgery and at 3 months after surgery,occurrence of complications and bone metabolism indicators[serum bone gla protein(BGP),procollagen typeⅠcarboxy-terminal peptide(PⅠCP),total procollagen typeⅠN-terminal propeptide(Total-PⅠNP)]before surgery and at 3 months after surgery were compared between the two groups.Result:The surgical time,postoperative hospital stay,fracture healing time and complete weight-bearing time of TPA group were shorter than those of TA group,the intraoperative blood loss was less than that of TA group(P<0.05).The clinical excellent and good rate of TPA group at 3 months after surgery was higher than that of TA group(87.88%vs 66.67%,P<0.05).Olerud-Molander functional scores and AOFAS ankle-posterior foot scores of both groups at 3 months after surgery were higher than those before surgery,those of TPA group were higher than those of TA group(P<0.05).The complication rate of TPA group was lower than of TA group(3.03%vs 20.00%,P<0.05).3 months after surgery,serum BGP and PⅠCP levels of both groups were higher than those before surgery,those of TPA group were higher than those of TA group,serum Total-PⅠNP levels were lower than those before surgery,that of TPA group was lower than than that of TA group(P<0.05).Conclusion:Compared with internal fixation via TA,internal fixation via TPA can better significantly shorten the surgical time,hospital stay,fracture healing time and complete weight-bearing time,lower the intraoperative blood loss,enhance the clinical efficacy,improve the postoperative ankle function,reduce the complications and promote the balance of bone metabolism in patients with supination-external rotation typeⅣAF.