后踝移位骨折的关节镜监视下复位经皮螺钉固定与开放复位疗效比较

Comparison of the efficacy of arthroscopic guided reduction and percutaneous screw fixation with open reduction for displaced posterior malleolar fractures

目的 比较后踝移位骨折的关节镜监视下复位经皮螺钉固定和后外侧入路开放复位之间的疗效。方法 回顾性分析武汉市第四医院骨科2017年12月至2020年12月间踝关节骨折合并后踝骨折行手术治疗的48例病例资料。其中,男39例,女9例;年龄32~74岁,平均45.5岁。根据后踝骨折的手术方式的不同,分为关节镜组21例,开放组27例。比较两组病例的止血带使用时间、骨愈合时间、影像评估、美国足踝外科协会踝与后足评分(American Orthopaedic Foot and Ankle Society, AOFAS)及手术相关不良反应。结果 48例患者获得完整随访,随访时间6~12个月,平均(8.23±1.56)个月。止血带使用时间:关节镜组[(77.7±12.3) min]长于开放组[(66.8±11.2) min],但差异无统计学意义(P>0.05);骨折愈合时间:关节镜组[(9.4±2.3)周]短于开放组[(10.2±3.1)周],但差异无统计学意义(P>0.05);影像评估:患者术后CT显示关节内台阶大于2 mm者关节镜组有3例,开放组有7例;术后6个月时AOFAS踝-后足评分:关节镜组[(80.6±8.4)分]高于开放组[(70.5±5.7)分],差异有统计学意义(P<0.05)。结论 与传统后外侧入路开放复位手术方式比较,采用后路关节镜监视下经皮复位螺钉固定后踝骨折,复位更精确,软组织损伤小,术后足踝部功能恢复更好,手术相关不良反应少,是一种可供选择的有效治疗方法。

Objective To compare the clinical outcomes of displaced posterior malleolar fractures treated with arthroscopy-guided percutaneous screw fixation and open reduction via posterolateral approach.Methods A retrospective analysis was conducted on the clinical data of 48 patients with ankle fractures combined with posterior malleolar fractures,who had underwent surgical treatment at Wuhan Fourth Hospital from December 2017 to December 2020.There were 39 males and 9 females,with a mean age of 45.5 years(range,32-74 years).According to the different surgical methods of posterior malleolus fracture fragments,21 cases were treated with percutaneous reduction and screw fixation under ankle arthroscopy(arthroscopic group),and 27 cases were treated with open reduction and fixation via posterolateral approach(open group).The duration of tourniquet application,bone healing time,imaging evaluation,American Orthopaedic Foot and Ankle Society ankle and hindfoot score(AOFAS)and surgery-related adverse reactions were compared between the two groups.Results Forty-eight patients were followed up for 6-12 months,with an average of(8.23±1.56)months.The duration of tourniquet application in the arthroscopic group[(77.7±12.3)min]was longer than that in the open group[(66.8±11.2)min],but the difference was not statistically significant(P>0.05).The bone healing time was(9.4±2.3)weeks in arthroscopic group and(10.2±3.1)weeks in open group(P>0.05).In the arthroscopic group,postoperative CT showed that the intra-articular step was more than 2 mm in 3 patients,and 7 cases in the open group.The AOFAS ankle-hindfoot score was(80.6±8.4)scores in the arthroscopic group,which was higher than(70.5±5.7)scores in the open group(P<0.05).Conclusion Compared with open reduction via posterolateral approach,posterior arthroscopic percutaneous reduction and screw fixation has the advantages of more accurate reduction,less soft tissue injury,better functional recovery of foot and ankle and less surgery-related adverse events.It is an alternative and effective treatment option.