空心螺钉内固定联合锁定钢板对踝关节骨折患者愈合情况和踝关节功能的影响

The impact of hollow screw internal fixation combined with locking plate on the healing and ankle joint function in patients with ankle fractures

目的探讨空心螺钉内固定联合锁定钢板对踝关节骨折患者愈合情况和踝关节功能的影响。方法选取2021年1月—2023年1月在中国人民解放军联勤保障部队第九〇一医院接受治疗的84例踝关节骨折患者。采用随机数字表法将患者分为对照组和观察组,各42例。对照组患者切开复位后采用普通钢板和克氏钉固定,观察组患者采用锁定钢板与空心螺钉固定。记录两组患者术后下床时间、术后住院时间和骨折愈合时间,比较两组患者术前和术后3个月的血清白细胞介素-6(IL-6)、IL-8、C反应蛋白(CRP)水平,比较术前和术后2年的踝关节活动度(背伸、跖屈、内翻、外翻)和影像学检测指标[胫骨远端前侧关节面角(TAS)、距骨倾斜角(TT)、胫骨踝穴角(TC)、胫骨侧位关节面角(TLS)],采用美国足踝外科协会(AOFAS)评分评估术后2年的踝关节功能。记录术后3个月内的并发症情况(切口感染、血肿、愈合畸形)。结果观察组患者术后下床时间、术后住院时间和骨折愈合时间、术后3个月的(IL-6)、IL-8、CRP水平差值均低于对照组(P<0.05),术后2年的关节活动度好于对照组(P<0.05),术后2年的TAS、TC、TLS、AOFAS评分差值均高于对照组(P<0.05),TT差值和并发症总发生率均低于对照组(P<0.05)。结论空心螺钉内固定与锁定钢板结合治疗可以缩短术后愈合时间,提高术后踝关节功能。

Objective To investigate the effect of combining hollow screw internal fixation with locking plate on the healing outcomes and ankle joint function in patients with ankle fractures.Methods A total of 84 patients with ankle fractures,treated between January 2021 and January 2023 at the 901st Hospital of the Joint Logistics Support Force,were selected for the study.Patients were randomly divided into a control group and an observation group,each consisting of 42 patients.The control group underwent open reduction and internal fixation using standard plates and Kirschner wires,while the observation group received locking plates combined with hollow screw fixation.Postoperative parameters recorded included time to ambulation,duration of hospitalization,and fracture healing time.Serum levels of interleukin-6(IL-6),IL-8,and C-reactive protein(CRP)were measured preoperatively and 3 months postoperatively.Ankle joint range of motion(dorsiflexion,plantarflexion,inversion,and eversion)and radiographic indicators(tibiotalar angle[TAS],talar tilt[TT],tibial plafond angle[TC],and lateral tibial surface angle[TLS])were compared preoperatively and 2 years postoperatively.Ankle function was assessed using the American Orthopaedic Foot&Ankle Society(AOFAS)score at 2 years post-surgery.Complications within 3 months postoperatively,such as wound infection,hematoma,and malunion,were also recorded.Results The observation group showed significantly shorter times to ambulation,hospital stays,and fracture healing compared to the control group(P<0.05).The differences in IL-6,IL-8,and CRP levels at 3 months postoperatively were lower in the observation group(P<0.05).At 2 years postoperatively,the observation group had superior ankle range of motion and higher TAS,TC,TLS,and AOFAS scores,with lower TT differences and a lower overall complication rate compared to the control group(P<0.05).Conclusion Combining hollow screw internal fixation with locking plate fixation in the treatment of ankle fractures can significantly shorten healing time and improve postoperative ankle function.