关节镜治疗Herscovici B和C型内踝骨折临床疗效

Clinical efficacy of arthroscopic treatment for Herscovici B and C type internal ankle fractures

目的探讨在踝关节镜下治疗Herscovici B和C型内踝骨折的短期临床疗效。方法2021年4月至2023年3月武汉市江夏区第一人民医院手术治疗的46例Herscovici B和C型内踝骨折患者,根据手术方法分为关节镜组(22例),切开复位组(24例),对两组患者围手术期(手术时间、住院时间、术中透视次数、术后影像学评估复位质量、术后并发症、术后VAS疼痛评分)和随访(骨折愈合时间及术后AOFAS评分)的指标进行比较,组间比较采用t检验分析。结果关节镜组患者住院时间[(7.73±1.28)d]优于切开复位组[(11.88±2.66)d],差异有统计学意义(t=6.828,P<0.05),术后并发症方面,关节镜组未出现伤口感染,血管疾神经损伤,但切开复位组出现2例大隐静脉损伤及1例隐神经损伤,且出现1例伤口浅表感染,关节镜组术后第3天及1周VAS评分分别为[(3.31±1.32)、(2.00±0.76)分]显著优于切开复位组[(5.50±1.22)、(4.13±0.95)分]差异有统计学意义(t=5.828、8.361,P<0.05),两组患者均完成随访,随访时间(8~10)月,平均(9.19±0.78),在随访中,两组患者术后AOFAS评分方面,术后3个月关节镜组[(83.09±3.94)分]优于切开复位组[(78.70±3.70)分],差异有统计学意义(t=3.891,P<0.05),末次随访关节镜组[(91.18±2.63)分]优于切开复位组[(86.88±4.46)分],差异有统计学意义(t=3.945,P<0.05),关节镜组患者骨折愈合时间[(7.11±1.06)周]优于切开复位组[(8.91±1.11)周],差异有统计学意义(t=5.630,P<0.05)。结论踝关节镜下治疗Herscovici B和C型内踝骨折微创,安全,临床效果优于切开复位,可作为临床治疗内踝骨折的另一种选择。

Objective To explore the short-term clinical effect of ankle arthroscopy in the treatment of Herscovici B and C medial malleolus fractures.Methods During the period spanning from April 2021 to March 2023,a total of 46 cases of Hercovicib.C type medial malleolus fractures were observed and treated at our hospital.These cases were categorised into two groups based on the surgical techniques employed:the arthroscopic group consisting of 22 cases,and the open reduction group comprising 24 cases.The study compared various indexes related to the perioperative period(such as operation time,hospitalisation time,times of fluoroscopy during operation,reduction quality of postoperative imaging evaluation,postoperative complications,and postoperative VAS pain score)and follow-up(including fracture healing time and postoperative AOFAS score)between the two groups.The measurement data were subjected to statistical analysis using the t test.Results The hospitalization time of patients in arthroscopy group[(7.73±1.28)days]was better than that in open reduction group[(11.88±2.66)days],and the difference was statistically significant(t=6.828,P<0.05).In terms of postoperative complications,there was no wound infection and vascular disease and nerve injury in arthroscopy group,but there were 2 cases of great saphenous vein injury and 1 case of saphenous nerve injury in open reduction group.In one instance,a superficial infection was observed in the wound.The Visual Analogue Scale(VAS)scores in the arthroscopy group demonstrated a statistically significant improvement compared to the open reduction group[(3.31±1.32),(2.00±0.76)points]on both the third day and one week following the surgical procedure[(5.50±1.22),(4.13±0.95)points].The difference was statistically significant(t=5.828,8.361,P<0.05).Patients in both groups completed follow-up.Conclusion Arthroscopic treatment of HerskoviciB.C type internal ankle fractures under ankle arthroscopy is minimally invasive,safe,and clinically superior to open reduction,making it an alternative option for clinical treatment of internal ankle fractures.