“CO踝架”治疗三踝骨折临床回顾性研究

A retrospective study on manual reduction combined with Chinese Orthopaedic ankle external fixator in the treatment of trimalleolar fracture

目的:评价中国接骨学(Chinese Osteosynthesis,CO)理论指导下按照三踝骨折独立分型揭示骨折移位规律指导手法复位,并配合外固定踝架治疗三踝骨折临床疗效。方法:回顾性分析2010年12月至2021年12月收治的118例三踝骨折患者的病例资料,其中53例采用手法复位配合外固定踝架穿针固定治疗(观察组),65例采用切开复位钢板螺钉内固定治疗(对照组)。比较两组患者在手术时间、住院天数、患肢非负重时间、骨折临床愈合时间、并发症发生率、术前及术后1个月疼痛视觉模拟评分(visual analogue scale,VAS)、术前及术后1年美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分之间的差异。结果:所有患者获得随访,时间14~70(35.28±14.66)个月。两组患者在手术时间、住院天数、患肢非负重时间、术后1个月VAS及骨折临床愈合时间方面比较,差异有统计学意义(P<0.05),术后1个月观察组VAS低于对照组(t=3.343,P=0.001),观察组手术时间明显短于对照组(t=9.091,P=0.000),观察组住院天数明显少于对照组(t=5.034,P=0.000),观察组患肢非负重时间明显短于对照组(t=11.960,P=0.000),观察组骨折临床愈合时间明显短于对照组(t=4.007,P=0.000)。术后1年两组患者AOFAS评分比较,差异无统计学意义(t=0.417,P=0.678)。观察组出现2例针孔感染,3例<2 mm的复位丢失;对照组发生3例手术切口感染;两组间并发症发生率比较,差异无统计学意义(χ^(2)=0.446,P=0.504)。结论:以CO接骨学理论为指导,按照三踝骨折独立分型揭示的骨折移位规律,指导手法复位及CO踝架分型治疗三踝骨折,能减少术中出血,缩短骨折愈合时间,促进踝关节功能恢复,具有良好的临床推广价值。

Objective To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis(CO)theory.Methods The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed.Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group).Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group).The operation time,hospitalization days,non-weight-bearing time of the affected limb,clinical healing time of fracture,incidence of complications,visual analogue scale(VAS)before and 1 month after operation,and American Orthopedic Foot and Ankle Society(AOFAS)score of ankle joint before and 1 year after operation were compared between the two groups.Results Patients in both groups were followed up for more than 1 year.All patients were followed up,and the duration ranged from 14 to 70 months,with an average of(35.28±14.66)months.There were statistically significant in operation time,hospitalization days,non-load-bearing time of affected limbs,clinical healing time of fractures and VAS score one month after operation between the two groups.One month after operation,the VAS score of the observation group was lower than that of the contro group(t=3.343,P=0.001).The operation time of the observation group was significantly shorter than that of the control group(t=9.091,P=0.000).The hospitalization days in the observation group were significantly less than those in the control group(t=5.034,P=0.000).The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960,P=0.000).The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007,P=0.000).There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417,P=0.678).In the observation group,there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm.There were 3 cases of surgical incision infection in the control group.There was no significant difference in the incidence of complications between the two groups(χ^(2)=0.446,P=0.504).Conclusion Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory,and the function of ankle joint recovers well after operation.This therapy has good clinical value.