经踝关节后内侧入路微型钢板内固定与空心钉内固定治疗BartonicekⅢ型后踝关节骨折的对比研究

Comparison of mini-plate internal fixation and cannulated screw internal fixation via posteromedial ankle approach in the treatment of Bartonicek type III posterior ankle fractures

目的比较经踝关节后内侧入路微型钢板内固定与空心钉内固定治疗BartonicekⅢ型后踝关节骨折的临床效果。方法选取2020年7月-2021年7月收治的98例BartonicekⅢ型后踝关节骨折患者为研究对象,根据系统化随机法将其分为观察组和对照组,各49例。对照组采用后内侧入路空心钉内固定术,观察组采用后内侧入路微型钢板内固定术。比较两组手术指标(手术时间、住院时间、骨折愈合时间、完全负重时间);比较术前和术后6个月两组踝关节活动度(背伸、跖屈、内翻、外翻)、美国矫形足与踝关节协会评分(AOFAS)变化;术后随访6个月,统计两组并发症发生情况。结果观察组手术时间、住院时间、骨折愈合时间、完全负重时间均低于对照组(P<0.05);术后6个月,两组踝关节背伸、跖屈活动度、AOFAS评分均升高(P<0.05),观察组高于对照组(P<0.05);两组踝关节内翻、外翻活动度均降低(P<0.05),且观察组低于对照组(P<0.05);两组并发症发生情况差异无统计学意义(P>0.05)。结论相较于空心钉内固定,经踝关节后内侧入路微型钢板内固定治疗BartonicekⅢ型后踝关节骨折疗效确切,可加快骨折愈合速度,促进踝关节功能恢复,且安全性良好。

Objective To compare the clinical effect of mini-plate internal fixation and cannulated screw internal fixation via posteromedial ankle approach in the treatment of Bartonicek type III posterior ankle fractures.Methods The 98 patients with Bartonicek type III posterior ankle fractures admitted to the hospital from July 2020 to July 2021 were selected as the research subjects.According to the systematic randomization method,the patients were divided into study group and control group,with 49 cases in each group.The patients in control group were treated with cannulated screw internal fixation via posteromedial approach while the patients in study group were given mini-plate internal fixation via posteromedial approach.The surgical indicators(surgical time,hospital stay,fracture healing time,full weight-bearing time),and ankle ranges of motions(dorsiflexion,plantarflexion,inversion,eversion)and American Orthopedic Foot and Ankle Society(AOFAS)score before surgery and at the 6th month after surgery were compared between two groups.The patients were followed up for 6 months after surgery,and the occurrence of complications of two groups were counted.Results The surgical time,hospital stay,fracture healing time and full weight-bearing time in study group were shorter than those in control group(P<0.05).At the 6th month after surgery,the ranges of motions of ankle dorsiflexion and plantarflexion and AOFAS score in two groups were increased(P<0.05),and the above indicators in study group were higher than those in reference group(P<0.05).The ranges of motions of ankle inversion and eversion were decreased in two groups(P<0.05),and the ranges of motions in study group were lower compared with those in control group(P<0.05).There were no statistical differences in the occurrence of complications between two groups(P>0.05).Conclusion Compared with cannulated screw internal fixation,Mini-plate internal fixation via posteromedial ankle approach has a more exact efficacy in the treatment of Bartonicek type III posterior ankle fractures,and can better accelerate the speed of fracture healing and promote the recovery of ankle function,and it has better safety.