正骨手法保守治疗旋后外旋型Ⅲ度和Ⅳ度踝关节骨折的临床研究

Conservative treatment of supination and external rotation for typeⅢandⅣankle fracture by bone setting

目的:探讨正骨手法保守治疗旋后外旋型Ⅲ、Ⅳ度踝关节骨折的临床疗效。方法:自2017年1月至2019年12月,对64例旋后外旋型Ⅲ、Ⅳ度踝关节骨折患者分别采用手法复位保守治疗(手法组)和切开复位钢板螺钉内固定术治疗(手术组),每组32例。手法组男17例,女15例,年龄15~79(51.42±13.68)岁;根据Lauge-Hansen分型,旋后外旋型Ⅲ度8例,Ⅳ度24例。手术组男13例,女19例;年龄18~76(47.36±15.02)岁;Lauge-Hansen分型旋后外旋型Ⅲ度7例,Ⅳ度25例。采用Digimizer软件测量并比较两组患者治疗前、治疗后3和12个月踝关节骨折移位程度,测算内踝侧方移位、内踝上下移位、外踝侧方移位、外踝前后移位、外踝短缩移位、后踝上下移位数值并进行比较,采用Mazur踝关节评分进行踝关节功能评价。结果:所有患者获得随访,时间12~36(17.16±9.36)个月。手法组复位前后踝关节内踝侧方移位、内踝上下移位、外踝侧方移位、外踝前后移位、外踝短缩移位、后踝上下移位比较,差异有统计学意义(P<0.05);手法组与手术组治疗后3个月内踝侧方移位、内踝上下移位、外踝侧方移位、外踝短缩移位比较,差异无统计学意义(P>0.05),外踝前后移位、后踝上下移位比较,差异有统计学意义(P<0.05)。治疗后3个月,手法组踝关节Mazur评分(68.84±13.08)分,与手术组(82.53±7.31)分比较,差异有统计学意义(P<0.05);两组疗效评定比较,差异无统计学意义(P>0.05)。治疗后12个月,两组踝关节Mazur评分和疗效评定比较,差异无统计学意义(P>0.05)。结论:运用正骨手法可有效纠正旋后外旋型Ⅲ、Ⅳ度踝关节骨折中内踝侧方移位、内踝上下移位、外踝侧方移位、外踝短缩移位,并具有良好的远期临床疗效,可以使部分患者避免手术,恢复患者骨折后踝关节功能。

Objective To explore curative effect of conservative treatment of supinationlateral rotation(SER)with typeⅢandⅣankle fracture by bone setting technique.Methods From January 2017 to December 2019,64 patients diagnosed with SER with typeⅢandⅣankle fracture were treated with manipulative reduction and conservative treatment(manipulation group)and surgical treatment with open reduction and internal fixation(operation group),32 patients in each group.In manipulation group,there were 17 males and 15 females,aged from 15 to 79 years old with an average of(51.42±13.68)years old;according to Lauge-Hansen classification,there were 8 patients with supination external rotation typeⅢand 24 patients with typeⅣ.In operation group,there were 13 males and 19 females,aged from 18 to 76 years old with an average of(47.36±15.02)years old;7 patients with typeⅢand 25 patients with typeⅣ.Displacement of ankle fracture was measured by Digimizer software,and compared before treatment,3 and 12 months after treatment between two groups.Lateral medial malleolus displacement,lateral medial malleolus displacement,lateral malleolus displacement,lateral malleolus displacement,lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups.Mazur score was used to evaluate ankle joint function.Results All patients were followed up from 12 to 36 months with an average of(17.16±9.36)months.There were statistical differences in lateral medial malleolus displacement,lateral medial malleolus displacement,lateral malleolus displacement,lateral malleolus displacement,lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(P<0.05).Compared with operation group,there were no statistically significant differences in lateral malleolus shift,lateral malleolus shift,lateral malleolus contraction shift(P>0.05),while there were statistically significant differences in lateral malleolus shift,posterior malleolus shift up and down(P<0.05).Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31,respectively,and had statistical differences(P<0.05),while there was no difference in evaluation of clnical effect(P>0.05).There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment(P>0.05).Conclusion Bone setting technique could effectively correct lateral displacement of medial malleolus,lateral displacement of medial malleolus,lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation typeⅢandⅣankle fracture,and has good longterm clinical effect,which could avoid operation for some patients and restore ankle function after fracture.