全踝关节镜下空心加压螺钉内固定术治疗青少年陈旧性外踝撕脱骨折伴踝关节不稳的疗效观察

Therapeutic effect of hollow compression screw internal fixation under total ankle arthroscopy for the treatment of old lateral malleolar avulsion fractures with ankle instability in adolescents

目的:探讨全踝关节镜下空心加压螺钉内固定术治疗青少年陈旧性外踝撕脱骨折伴踝关节不稳的临床效果。方法:病例系列报告。纳入2018年11月—2022年9月徐州市中心医院手足显微外科收治的陈旧性外踝撕脱骨折伴踝关节不稳的青少年患者13例(13足),其中男6例、女7例,年龄13~18(16.1±1.3)岁,左侧5例、右侧8例,受伤至手术时间6~11(8.2±1.7)个月。所有患者在全踝关节镜下行骨折复位空心加压螺钉内固定术治疗。观察患者围手术期指标及术后并发症情况;术后定期随访,观察并记录患者骨折愈合时间、踝关节稳定性及行走步态;比较术前与末次随访时踝关节疼痛视觉模拟评分法(VAS)评分、美国足踝外科协会(AOFAS)踝-后足评分、足踝预后评分(FAOS)以评价手术临床效果及踝关节功能。结果:13例患者手术均获成功,手术时间35~75(53.2±11.1)min、术中出血量4~8(5.1±1.2)mL、住院时间5~7(6.1±1.0)d,所有患者手术切口一期愈合,未出现血管、神经及肌腱损伤等并发症。13例患者均获得随访,随访时间14~40(24.3±3.5)个月。患者骨折愈合时间术后7~11(9.1±1.0)周。末次随访时,所有患者踝关节外观满意、稳定性恢复良好,踝关节抽屉试验阴性,无屈伸活动受限、行走步态异常及负重行走性疼痛。末次随访时,患者踝关节疼痛VAS评分为(0.69±0.48)分、低于术前的(6.62±1.45)分,AOFAS踝-后足评分和FAOS分别为(92.77±2.62)分和(93.54±2.93)分、高于术前的(65.54±5.79)分和(66.38±5.81)分,差异均有统计学意义(t=17.01、23.45、24.63,P值均<0.001)。结论:全踝关节镜下骨折复位空心加压螺钉内固定可精准重建外踝解剖结构,恢复踝关节功能及稳定性,是治疗青少年陈旧性外踝撕脱骨折伴踝关节不稳的一种有效治疗方法。

Objective This study aimed to explore the clinical effect of hollow compression screw internal fixation under total ankle arthroscopy in the treatment of old lateral ankle avulsion fractures with ankle instability in adolescents.Methods This study was a case series report.Thirteen adolescent patients(13 feet)with old external ankle avulsion fractures and ankle instability admitted to the Department of Foot and Ankle surgery,Xuzhou Central Hospital from November 2018 to September 2022 were included,including six males and seven females,aged 13-18(16.1±1.3)years old.There were five cases on the left and eight cases on the right,and the time from injury to surgery was 6-11(8.2±1.7)months.All patients underwent reduction of fractures under full ankle arthroscopy using hollow compression screws for fixation.Perioperative indicators and postoperative complications were observed in these patients.Regular follow-up was recommended postoperatively,the patient's fracture healing time,ankle joint stability,and walking gait were observed and recorded.The visual analog scale(VAS)for ankle pain was compared between preoperative and final follow-up,the American Orthopaedic Foot and Ankle Society(AOFAS)ankle posterior foot scale,and the foot and ankle outcome score(FAOS)to evaluate the clinical efficacy of surgery and ankle joint function.Results All 13 patients in this group underwent successful surgeries,with a surgical duration of 35-75(53.2±11.1)min,intraoperative blood loss of 4-8(5.1±1.2)mL,and a hospital stay of 5-7(6.1±1.0)days.All patients had primary healing of surgical incisions,with no complications such as vascular,nerve,or tendon injuries.All 13 patients in this group were followed up for a period of 14-40(24.3±3.5)months.All patients'fractures healed within 7-11(9.1±1.0)weeks postoperatively.At the last follow-up,all patients had satisfactory ankle joint appearance,good stability recovery,negative ankle drawer test,no restricted flexion and extension activity,no abnormal walking gait,and no pain when bearing weight.The VAS score for ankle pain at the last follow-up was(0.69±0.48)points,which was lower than the preoperative score of(6.62±1.45)points.The AOFAS score and FAOS were(92.77±2.62)points and(93.54±2.93)points,respectively,which were higher than the preoperative scores of(65.54±5.79)points and(66.38±5.81)points,respectively.The differences were statistically significant(t=17.01,23.45,24.63;all P values<0.001).Conclusion Under total ankle arthroscopy,the reduction of fractures and internal fixation with hollow compression screws can accurately reconstruct the anatomical structure of the external ankle and restore the ankle joint function and stability.This approach is also an effective treatment method for adolescent-old external ankle avulsion fractures with ankle instability.