中前足骨折不同内固定方式的临床疗效对比分析

Comparative analysis of clinical efficacy of different internal fixation methods in midfoot and forefoot fractures

目的研究中前足骨折不同内固定方式的临床疗效。方法回顾性分析首都医科大学附属北京潞河医院收治的通过可吸收螺钉进行内固定的中前足骨折患者33例的临床资料并将其纳入观察组,另将同期通过钛合金螺钉进行内固定的33例中前足骨折患者纳为对照组。记录比较2组围术期指标,通过Maryland足踝功能评分、美国足踝外科协会(American Orthopaedic Foot and Ankle Surgery Association,AOFAS)踝与后足评分评估2组术前及术后3个月足踝功能情况,检测2组炎症因子[降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)]水平,观察比较2组并发症发生情况。结果观察组手术时间、住院时间、骨折愈合时间显著小于对照组(t=3.492、2.607、7.581,P<0.05)。术后3个月,2组Maryland评分、AOFAS评分较术前高(P<0.05),且观察组高于对照组(t=3.034、3.041,P<0.05)。术后3个月,2组PCT、IL-6、CRP水平较术前低(P<0.05),且观察组低于对照组(t=3.816、10.315、10.050,P<0.001)。2组并发症总发生率比较无统计学意义(χ^(2)=2.747,P=0.099)。结论可吸收螺钉内固定用于中前足骨折手术疗效显著,能够促进骨折及足踝功能恢复,减轻患者炎症反应,且安全性较高,值得临床应用与推广。

Objective To investigate the clinical efficacy of different internal fixation methods for midfoot and forefoot fractures.Methods The clinical data of 33 patients with midfoot and forefoot fractures who underwent internal fixation with absorbable screws in Beijing Luhe Hospital Affiliated to Capital Medical University were retrospectively analyzed and included in the observation group.In addition,33 patients with midfoot and forefoot fractures who underwent internal fixation with titanium alloy screws in our hospital during the same period were included in the control group.Perioperative indicators of two groups were recorded and compared,and the foot and ankle function in both groups surgery before and at 3 months after surgery were evaluated using Maryland Foot Score(MFS)and American Orthopaedic Foot and Ankle Society(AOFAS)Ankle-Hindfoot Score.The levels of inflammatory cytokines[procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP)]in the two groups were detected,and the incidence of complications between the two groups was observed and compared.Results The duration of operation,length of hospitalization and duration of fracture healing in observation group were significantly shorter than those in control group(t=3.492,2.607,7.581,P<0.05).At 3 months after surgery,MFS and AOFAS scores in both groups were higher than those before surgery(P<0.05),and higher in the observation group than in the control group(t=3.034,3.041,P<0.05).At 3 months after surgery,the levels of PCT,IL-6 and CRP in the two groups were lower than those before surgery(P<0.05),and lower in the observation group than in the control group(t=3.816,10.315,10.050,P<0.001).There was no significant diffence in the total incidence of complications between the two groups(χ^(2)=2.747,P=0.099).Conclusion Internal fixation with absorbable screw in the surgical treatment of midfoot and forefoot fracture has a significant effect,which can promote the recovery of fracture and ankle function,reduce the patient′s inflammatory response,and has a high safety.Therefore,it is worthy of clinical application and promotion.