两种方式手法复位石膏固定踝关节骨折的比较

Comparison of two methods of manual reduction and external fixation with plaster splint for ankle fractures

[目的]比较龚氏四步复位法石膏外固定与常规手法复位石膏外固定治疗踝关节骨折的效果。[方法]回顾性分析本院2020年6月—2022年6月手法复位的90例踝关节骨折患者的临床资料。根据术前医患沟通结果,45例接受龚氏四步复位石膏外固定(龚氏组),45例接受常规手法复位石膏外固定(常规组)。比较两组临床与影像资料。[结果]随治疗后时间推移,两组踝VAS评分均下降(P<0.05),而AOFAS评分和踝ROM均显著增加(P<0.05)。治疗后6个月,龚氏组的VAS评分[(1.9±0.3) vs (2.4±0.3), P<0.001],AOFAS评分[(90.3±3.9) vs (86.4±4.4), P<0.001]和踝ROM [(51.4±4.9)°vs (49.0±5.2)°, P=0.027]均显著优于常规组。影像方面,两组关节面复位质量的差异无统计学意义(P>0.05)。治疗后龚氏组的胫踝角(tibiocrural angle,TCA)[(76.5±4.8)ovs (73.8±4.5)°, P=0.007]、踝内侧净间隙(medial clear space, MCS)[(3.5±0.3)mm vs (3.9±0.4)mm, P<0.001]及胫腓净间隙(tibiofibular clear space, TFCS)[(6.0±1.5)mm vs (6.6±1.2)mm, P=0.039]均显著优于常规组。[结论]两种方式手法复位均可有效治疗踝关节骨折,其中龚氏四步复位法石膏固定的疗效优于常规手法复位石膏外固定。

[Objective]To compare the clinical efficiency of Gong's four-step reduction and plaster-splint external fixation versus con⁃ventional manual reduction and plaster-splint external fixation in the treatment of ankle fractures.[Methods]A retrospective study was conducted on 90 patients who received manual reduction and external fixation with plaster splint for ankle fractures in our hospital from June 2020 to June 2022.According to preoperative doctor-patient communication,45 patients received Gong's four-step reduction and plaster external fixation(the Gong's group),wile the other 45 cases received conventional manual reduction plaster external fixation(the conventional group).The clinical and imaging data were compared between the two groups.[Results]The VAS scores significantly de⁃creased(P<0.05),while the AOFAS score and ankle ROM significantly increased in both groups over time after treatment(P<0.05).The Gong's group proved significantly superior to the conventional group in terms of VAS score[(1.9±0.3)vs(2.4±0.3),P<0.001],AOFAS score[(90.3±3.9)vs(86.4±4.4),P<0.001]and ankle ROM[(51.4±4.9)°vs(49.0±5.2)°,P=0.027)6 months after treatment.Regarding imaging,there was no significant difference in articular surface reduction quality between the two groups(P>0.05),but the Gong's group was signifi⁃cantly better than the conventional group in terms of tibiocrural angle(TCA)[(76.5±4.8)°vs(73.8±4.5)°,P=0.007],medial clear space(MCS)[(3.5±0.3)mm vs(3.9±0.4)mm,P<0.001]and tibiofibular clear space(TFCS)[(6.0±1.5)mm vs(6.6±1.2)mm,P=0.039]after treatment.[Conclusion]Both techniques of manual reduction do effectively treat ankle fractures.By comparison,the Gong's four-step reduction and plaster external fixation is superior to conventional manual reduction plaster external fixation.