闭合复位经皮空心钉固定治疗单纯外踝关节骨折患者的效果评价

Evaluation of Closed Reduction and Percutaneous Cannulated Nail Fixation in the Treatment of Simple External Ankle Fracture

目的:探究闭合复位经皮空心钉固定在单纯外踝关节骨折患者治疗中的应用价值。方法:选取华侨大学附属厦门长庚医院2020年1月—2022年1月收治的59例单纯外踝关节骨折患者,根据随机数表法分为闭合组(n=30)和传统组(n=29)。闭合组实施闭合复位经皮空心钉固定术,传统组实施传统切开复位固定术,术后两组均给予常规处理。对比两组围手术期指标、并发症发生情况、血流动力学指标、体液免疫功能及疼痛评分[视觉模拟评分法(VAS)]、踝关节功能评分[Marland足部功能量表(MFS)]。结果:闭合组术中出血量少于传统组,手术时间、住院时间、骨折愈合时间短于传统组,差异有统计学意义(P<0.05);两组并发症总发生率比较,差异无统计学意义(P>0.05);术后7 d,两组的舒张期峰值流速(DPV)、收缩期峰值流速(SPV)、阻力指数(RI)较术前改善,且闭合组改善幅度大于传统组,差异有统计学意义(P<0.05);术后7 d,两组的免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平较术前下降,但闭合组高于传统组,差异有统计学意义(P<0.05);随访期间两组无脱落病例,术后6个月,两组VAS评分、MFS评分较术前改善,且闭合组改善幅度大于传统组,差异有统计学意义(P<0.05)。结论:闭合复位经皮空心钉固定术治疗单纯外踝关节骨折患者能优化手术路径,改善血流动力学指标,减轻免疫功能损害,有助于骨折断端愈合,减轻疼痛,恢复患者踝关节功能,且不增加并发症发生率。

Objective:To explore the application value of closed reduction and percutaneous cannulated nail fixation in the treatment of simple external ankle fracture.Method:A total of 59 patients with simple external ankle fracture admitted to Xiamen Changgeng Hospital Affiliated to Huaqiao University from January 2020 to January 2022 were divided into closed group(n=30)and traditional group(n=29)by random number table method.The closed group was treated with closed reduction and percutaneous cannulated nail fixation,while the traditional group was treated with traditional open reduction and fixation.After surgery,both groups were given routine treatment.Perioperative indicators,complications,hemodynamics,humoral immune function,and pain scores[visual analogue scale(VAS)],and ankle joint function scores[Marland foot function scale(MFS)]were compared between the two groups.Result:The amount of intraoperative bleeding in the closed group was less than that in the traditional group,and the operative time,hospitalization time,and fracture healing time in the closed group were shorter than those in the traditional group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).At 7 d after surgery,the diastolic peak velocity(DPV),systolic peak velocity(SPV),and resistance index(RI)of the two groups were improved compared to those before surgery,and the improvement in the closed group were greater than those in the traditional group,the differences were statistically significant(P<0.05).At 7 d after surgery,the levels of immunoglobulin A(IgA),immunoglobulin M(IgM),and immunoglobulin G(IgG)of the two groups were decreased compared to those before surgery,but the closed group were higher than those in the traditional group,the differences were statistically significant(P<0.05).During the follow-up period,there were no cases of shedding in the two groups.At 6 months after surgery,the VAS scores and MFS scores in the two groups were improved compared to those before surgery,and the improvement range in the closed group were greater than those in the traditional group,the differences were statistically significant(P<0.05).Conclusion:Closed reduction and percutaneous cannulated nail fixation for the treatment of patients with simple external ankle fractures can optimize the surgical path,improve hemodynamic indicators,reduce immune function damage,help fracture healing,alleviate pain,and restore patient ankle function,and does not increase the incidence of complications.