改良后外侧入路联合内侧入路切开复位内固定治疗老年三踝骨折的效果

Effect of Modified Posterolateral Approach Combined with Inside Approach for Open Reduction and Internal Fixation in the Treatment of Senium Trimalleolar Fractures

目的:探讨改良后外侧入路联合内侧入路切开复位内固定治疗老年三踝骨折的效果。方法:选取2018年4月—2022年12月龙岩市第二医院收治的80例老年三踝骨折患者。根据随机数表法将其分为传统组(n=40)和改良组(n=40)。改良组给予改良后外侧入路联合内侧入路切开复位内固定,传统组给予传统后外侧入路联合内侧入路切开复位内固定。比较两组围手术期指标,术后1d、3d、1周疼痛程度,术前、术后6个月踝关节活动度及踝关节功能,术前、术后第1天炎症因子及并发症。结果:改良组术中出血量少于传统组,差异有统计学意义(P<0.05)。改良组术后1周视觉模拟评分法(VAS)评分低于传统组,差异有统计学意义(P<0.05)。术后6个月,两组踝关节跖屈、背伸活动度、美国足踝外科协会(AOFAS)评分均升高,改良组踝关节背伸活动度高于传统组,差异有统计学意义(P<0.05)。术后第1天,两组C反应蛋白(CRP)、降钙素原(PCT)水平均升高,改良组CRP、PCT水平略低于传统组,但两组比较,差异无统计学意义(P>0.05)。改良组患肢感觉麻痹、感染发生率均低于传统组,差异有统计学意义(P<0.05)。结论:在老年三踝骨折患者的手术治疗方面,改良后外侧入路联合内侧入路具有与传统外侧入路联合内侧入路切开复位内固定治疗相当的手术效果,且不影响患者术后炎症相关因子水平,但相较而言,改良后患者疼痛程度更轻,踝关节功能恢复越快,术后并发症也相对较少。

Objective:To investigate the effect of modified posterolateral approach combined with inside approach for open reduction and internal fixation in the treatment of senium trimalleolar fractures.Method:A total of 80 elderly patients with trimalleolar fracture treated in the Second Hospital of Longyan from April 2018 to December 2022 were selected.They were divided into traditional group(n=40)and modified group(n=40)according to random number table method.The modified group was given the modified posterolateral approach combined with the inside approach for open reduction and internal fixation,and the traditional group was given the traditional posterolateral approach combined with the inside approach for open reduction and internal fixation.Perioperative indexes,pain degree 1 d,3 d and 1 week after surgery,ankle joint motion and ankle joint function before surgery and 6 months after surgery,inflammatory factors before surgery and the first day after surgery and complications were compared between the two groups.Result:The amount of intraoperative blood loss in the modified group was less than that in the traditional group,and the difference was statistically significant(P<0.05).The visual analogue scale(VAS)score of the modified group was lower than that of the traditional group 1 week after surgery,and the difference was statistically significant(P<0.05).Six months after surgery,ankle plantar flexion,dorsal-extension motion and American Association of Foot and Ankle Surgery(AOFAS)score were increased in both groups,and the dorsal-extension motion of ankle joint in the modified group was higher than that in the traditional group,the differences were statistically significant(P<0.05).On the first day after surgery,C-reactive protein(CRP)and procalcitonin(PCT)levels were increased in both groups,and the CRP and PCT levels in the modified group were slightly lower than those in the traditional group,but there was no statistical significance between the two groups(P>0.05).The incidences of sensory paralysis of affected limb and infection in the modified group was lower than that in the traditional group,and the difference was statistically significant(P<0.05).Conclusion:In the surgical treatment of elderly patients with trimalleolar fractures,the modified posterolateral approach combined with the inside approach has the same surgical effect as the traditional lateral approach combined with the inside approach in open reduction and internal fixation,and does not affect the levels of postoperative inflammation-related factors levels in patients after surgery.However,the modified patients have less pain and faster ankle function recovery.Postoperative complications were also relatively rare.