改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果

Clinical Effect of Modified Ankle Joint Posterolateral Approach Combined with Medial Approach for Open Reduction and Internal Fixation in Treatment of Trimalleolar Fracture

目的:探讨改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果。方法:选取2020年2月—2021年12月麻城市人民医院收治的三踝骨折患者72例作为研究对象,采用双盲法分为对照组和试验组,各36例。两组患者均行切开复位内固定术治疗,对照组采用常规踝关节后外侧入路联合内侧入路,试验组采用改良踝关节后外侧入路联合内侧入路。比较两组治疗效果。结果:试验组并发症总发生率低于对照组,差异有统计学意义(P=0.006)。治疗前,两组踝关节背伸、跖屈、外翻、内翻活动度比较,差异无统计学意义(P>0.05);治疗后6个月,两组踝关节背伸、跖屈、外翻、内翻活动度均大于治疗前,且试验组大于对照组,差异有统计学意义(P<0.05)。治疗前,两组美国矫形足踝学会(AOFAS)踝-后足指数评分量表评分比较,差异无统计学意义(P>0.05);治疗后6个月,两组AOFAS踝-后足指数评分量表评分高于治疗前,且试验组高于对照组,差异有统计学意义(P<0.001)。结论:改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果显著,能改善踝关节活动度与功能,减少并发症。

Objective:To investigate the clinical effect of modified ankle joint posterolateral approach combined with medial approach for open reduction and internal fixation in treatment of trimalleolar fracture.Methods:Seventy-two patients with trimalleolar fracture admitted to People's Hospital of Macheng City from February 2020 to December 2021 were selected as the study subjects.They were divided into control group and experimental group with 36 patients in each group by double-blind method.All patients in two groups were treated with open reduction and internal fixation.The control group was treated with conventional ankle joint posterolateral approach combined with medial approach,and the experimental group was treated with modified ankle joint posterolateral approach combined with medial approach.The treatment effects were compared between the two groups.Results:The total incidence of complications in the experimental group was lower than that in the control group,and the difference was statistically significant(P=0.006).Before treatment,there was no significant difference in the ranges of motion of ankle joint dorsal extension,plantar flexion,valgus and varus between the two groups(P>0.05);At 6 months after treatment,the ranges of motion of ankle joint dorsal extension,plantar flexion,valgus and varus in the two groups were higher than those before treatment,and these ranges in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in the score of American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale between the two groups(P>0.05);At 6 months after treatment,the scores of the AOFAS ankle-hindfoot scale in the two groups were higher than those before treatment,and these scores in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.001).Conclusion:The modified ankle joint posterolateral approach combined with medial approach for open reduction and internal fixation has significant clinical effects in treatment of trimalleolar fracture,and can improve the range of motion and function of ankle joint,and reduce the complications.