高压氧联合内固定治疗对踝关节骨折患者临床疗效及踝关节功能恢复的影响

Clinical efficacy of hyperbaric oxygen combined with internal fixation in patients with ankle fracture and its effect on ankle functional recovery

目的探讨高压氧联合内固定治疗对踝关节骨折患者临床疗效及踝关节功能恢复的影响。方法选取2020年8月至2022年9月运城市中心医院关节外科收治的90例踝关节骨折患者作为研究对象,按照随机数字表法分为对照组和研究组,每组45例。对照组患者采用经皮微创空心螺钉内固定治疗,研究组在对照组治疗的基础上给予高压氧治疗。比较2组患者治疗后的骨折愈合时间、肿痛消失时间和完全负重时间。采用酶联免疫吸附法测定治疗前后患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平。检测2组患者治疗后角速度120°时踝关节肌肉收缩相对峰力量、力矩加速能和耐力,评估等速肌力。在治疗前及治疗3个月后,采用Olerud-Molander踝关节主观评分(OMAS)、美国矫形足踝学会(AOFAS)评分和Kofoed评分评估2组患者术后踝关节功能的恢复情况。记录2组患者术后钉道感染、切口感染、深静脉血栓等并发症发生情况。结果研究组患者治疗后骨折愈合时间、肿痛消失时间和完全负重时间均明显短于对照组(P<0.01)。与治疗前比较,2组患者治疗后血清TNF-α和IL-6水平明显降低,且研究组治疗后上述指标均明显低于对照组(P<0.01)。研究组患者治疗后外翻、内翻、趾屈、背伸的相对峰力量、力矩加速能、耐力均显著高于对照组(P<0.01)。与治疗前比较,2组患者治疗后OMAS评分、AOFAS评分、Kofoed评分明显提高,且研究组治疗后上述指标均明显高于对照组(P<0.01)。研究组术后并发症发生率(6.67%)明显低于对照组(22.22%),差异有统计学意义(P<0.05)。结论高压氧联合内固定治疗可以显著减轻踝关节骨折患者的炎症反应,提高临床疗效,促进踝关节功能恢复。

Objective To study the clinical efficacy of hyperbaric oxygen(HBO)combined with internal fixation in patients with ankle fracture and its effect on ankle functional recovery.Methods A total of 90 patients with ankle fracture admitted to the Department of Joint Surgery of Yuncheng Central Hospital from August 2020 to September 2022 were selected as the research objects.According to the random number table method,they were divided into control group and study group,with 45 cases in each group.The patients in the control group were treated with minimally invasive percutaneous cannulated screw internal fixation,and the patients in the study group were treated with HBO therapy on the basis of the treatment of the control group.The fracture healing time,swelling and pain disappearance time,and full weight-bearing time were compared between the two groups.The levels of serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were measured by enzyme-linked immunosorbent assay before and after treatment.The relative peak strength,torque acceleration energy,and endurance of ankle muscle contraction at angular velocity of 120°after treatment were detected in the two groups,and the isokinetic muscle strength was evaluated.Before and three months after treatment,the Olerud-Molander ankle subjective score(OMAS),the American Orthopaedic Foot&Ankle Society(AOFAS)score,and the Kofoed score were used to evaluate the recovery of ankle function in the two groups.The postoperative complications such as nail tract infection,incision infection,and deep vein thrombosis were observed in the two groups.Results The fracture healing time,swelling and pain disappearance time,and full weight-bearing time in the study group were significantly shorter than those in the control group(P<0.01).Compared with those before treatment,the levels of serum TNF-αand IL-6 in the two groups significantly decreased after treatment,and the above indexes in the study group were significantly lower than those in the control group(P<0.01).After treatment,the relative peak strength,torque acceleration energy and endurance of valgus,varus,toe flexion,and dorsiflexion in the study group were significantly higher than those in the control group(P<0.01).Compared with before treatment,the Olerud-Molander score,AOFAS score,and Kofoed score of the two groups were significantly improved after treatment,and the above indexes in the study group were significantly higher than those in the control group(P<0.01).The total incidence of postoperative complications in the study group(6.67%)was significantly lower than that in the control group(22.22%),and the difference was statistically significant(P<0.05).Conclusion HBO combined with internal fixation can significantly reduce the inflammatory reaction of patients with ankle fracture,improve the clinical efficacy,and promote the functional recovery of ankle joint.