后外侧入路下不同内固定术治疗旋后外旋型Ⅲ~Ⅳ度踝关节骨折的临床比较

Clinical comparison of different internal fixations via the posterolateral approach for the treatment of type Ⅲ~Ⅳ supination-external rotation ankle joint fractures

目的 研究后外侧入路下不同内固定术治疗旋后外旋型Ⅲ~Ⅳ度踝关节骨折的临床疗效。方法 前瞻性随机对照研究,以医院2019年1月至2021年1月需行后外侧下内固定术治疗的100例旋后外旋型Ⅲ~Ⅳ度踝关节骨折作为研究对象,采用随机数字表法将其分为A组和B组,每组50例。A组采用经后外侧入路螺钉内固定术治疗;B组采用后外侧入路钢板内固定治疗,2组患者术后均随访18个月。比较2组患者临床指标,骨折骨性愈合时间、末次随访时患者的踝关节功能以及术后18个月内并发症的发生情况。结果 研究期间2组患者均未有脱落;A组患者手术时间明显短于B组,术中出血量明显少于B组,差异均有统计学意义(P<0.05),2组患者住院时间比较,差异无统计学意义(P>0.05);2组患者骨折骨性愈合时间比较,差异无统计学意义(P>0.05);A组患者美国矫形足踝协会踝-后足评分系统(AOFAS)踝关节功能与B组比较,差异无统计学意义(P>0.05);2组并发症发生率比较,差异无统计学意义(P>0.05)。结论 后外侧入路下螺钉内固定与钢板内固定对旋后外旋型Ⅲ~Ⅳ度踝关节骨折患者具有相当的治疗效果,但经外侧入路螺钉内固定能够缩短手术时间,减少术中出血量。

Objective To compare the clinical efficacy of different internal fixations via the posterolateral approach for the treatment of typeⅢ~Ⅳsupination-external rotation ankle joint fractures.Methods A prospective randomized controlled study was conducted,involving 100 patients with typeⅢ~Ⅳsupination-external rotation ankle joint fractures treated with posterolateral internal fixation between January 2019 and January 2021.They were randomly divided into group A(50 cases)and group B(50 cases).Patients in group A were treated with posterolateral screw internal fixation and those in group B were treated with posterolateral plate internal fixation.All patients were followed up for 18 months.The clinical indexes,fracture healing time,ankle joint function at the last follow-up and complications within 18 months of surgery were compared between the two groups.Results During the study period,none of drop-out cases were reported.Patients in group A had significantly shorter surgery time and less intraoperative bleeding volume than those in group B(both P<0.05).There were no significant differences in the length of stay,fracture healing time,the American Orthopaedic Foot&Ankle Society(AOFAS)score and incidence of complications between groups(all P>0.05).Conclusion Posterolateral screw internal fixation and plate internal fixation have a considerable therapeutic effect on patients with typeⅢ~Ⅳsupination-external rotation ankle joint fractures,but the former can shorten the operation time and reduce intraoperative bleeding.