改良踝关节后外侧入路联合内侧复位固定对三踝骨折患者骨折愈合及踝关节功能的影响

Effect of Modified Posterolateral Approach of Ankle Joint Combined with Medial Approachfor Reduction and Fixation on Fracture Healing and Ankle Function in Patientswith Trimalleolar Fracture

目的 研究改良踝关节后外侧入路(PLA)联合内侧入路(MA)复位固定对三踝骨折患者骨折愈合及踝关节功能的影响。方法 选取2021年12月-2022年12月天津市蓟州区人民医院收治的70例三踝骨折患者,经随机数字表法分为对照组(35例)与观察组(35例)。对照组应用传统踝关节PLA+MA复位固定治疗,观察组则应用改良踝关节PLA+MA复位固定治疗,比较两组术后恢复时间(骨痂形成时间、骨折愈合时间、完全负重行走时间)、踝关节功能[美国矫形外科足踝协会(AOFAS)踝-后足功能评分、踝关节活动度(背伸、跖屈)]、手术并发症、康复效果。结果 观察组骨痂形成时间、骨折愈合时间、完全负重行走时间短于对照组(P<0.05);两组治疗后3个月AOFAS踝-后足功能评分、踝关节活动度(背伸、跖屈)均大于治疗前,且观察组AOFAS踝-后足功能评分、踝关节活动度(背伸、跖屈)大于对照组(P<0.05);观察组手术并发症发生率低于对照组(P<0.05);观察组治疗后6个月康复优良率高于对照组(P<0.05)。结论 改良踝关节PLA联合MA复位固定治疗三踝骨折的效果肯定,可加速患者骨折愈合,改善其踝关节功能,降低手术并发症风险,提高其康复效果。

Objective To study the clinical effect of modified posterolateral approach(PLA)combined with medial approach(MA)for reduction and fixation on fracture healing and ankle function in patients with trimalleolar fracture.Methods A total of 70 patients with trimalleolar fractures admitted to Tianjin Jizhou District People's Hospital from December 2021 to December 2022 were selected and divided into control group(35 patients)and observation group(35 patients)by random number table method.The control group was treated with traditional ankle joint PLA+MA for reduction and fixation,while the observation group was treated with modified ankle joint PLA+MA for reduction and fixation.The postoperative recovery time(callus formation time,fracture healing time,full weight-bearing walking time),ankle joint function[American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot function score,ankle joint range of motion(dorsiflexion,plantar flexion)],surgical complications and rehabilitation effects were compared between the two groups.Results The callus formation time,fracture healing time and full weight-bearing walking time in the observation group were shorter than those in the control group(P<0.05).After 3 months of treatment,the AOFAS ankle-hindfoot function score and ankle joint activity(dorsiflexion and plantar flexion)of the two groups were higher than those before treatment,and the AOFAS ankle-hindfoot function score and ankle joint activity(dorsiflexion and plantar flexion)of the observation group were higher than those of the control group(P<0.05).The incidence of surgical complications in the observation group was lower than that in the control group(P<0.05).The excellent and good rate of rehabilitation in the observation group was higher than that in the control group at 6 months after treatment(P<0.05).Conclusion Modified ankle joint PLA combined with MA for reduction and fixation is effective in the treatment of trimalleolar fractures,which can accelerate fracture healing,improve ankle function,reduce the risk of surgical complications,and improve the rehabilitation effect.