两种经皮螺钉内固定微创手术治疗踝关节骨折的疗效对比

Comparative study of the curative effects of two percutaneous screw fixation minimally invasive surgery for ankle fractures

目的:比较两种同是微创的闭合复位经皮螺钉内固定术治疗踝关节骨折的疗效。方法:对比分析我院2009年1月~2015年9月期间收治的114例内、外、后三踝骨折,内、外踝双骨折,内、后踝骨折或者单纯内踝骨折患者的临床资料,对他(她)们均采用闭合复位经皮内固定术治疗,根据内固定物不同分为常规空心螺钉组和无头加压螺钉组,比较两组患者的术中出血量、手术时间、术后感染及皮肤坏死、骨折愈合时间、踝关节功能恢复及骨折愈合(时间)后的AOFAS评分。结果:两组患者的术中出血量、手术时间、术后感染及皮肤坏死差异无显著性,但无头加压螺钉组患者的骨折愈合时间、固定牢固程度及踝关节功能恢复明显优于常规空心螺钉组,AOFAS踝关节-后足评分:优76例,良29例,一般9例。结论:虽然同是经皮螺钉内固定微创手术治疗踝关节骨折,但是无头双加压螺钉内固定方法具有固定更牢固、骨折愈合时间短、无内固定物外露的优点。

Objective The study aims to compare two types of minimally invasive surgery for the treatment of ankle fractures,which applies the method of closed reduction and percutaneous screw fixation.Methods The study conducts a comparative analysis of 114 cases from our hospital during January 2009-September 2015,including the treatment for medial,lateral and back malleolus fractures,internal and lateral malleolus fractures,internal and back malleolus,and medial malleolus.Closed reduction and percutaneous fixation were applied in the treatment for all the patients.According to the application of different internal fixation materials,the cases are divided into two groups:one using conventional hollow screws,another using headless compression screw.The study compares the amount of blood loss in operation,operation time,postoperative infection and skin necrosis,the duration of fracture healing,the functional recovery of the anckle and the AOFAS score after recovery(the healing period).Results There is no significant difference in the amount of blood loss in operation,operation time,postoperative infection and skin necrosis between the two groups.However,the results of the headless compression screw group is distinctly better than the conventional hollow screw group,in terms of the duration of fracture healing,the firmness of fixation,the functional recovery of the ankle and AOFAS score for ankle-metapedes,with 76 cases scoring excellent,29 cases scoring good,and 9cases scoring average.Conclusion Although both methods apply percutaneous screw fixation in the minimally invasive surgery to treat ankle fracture,the method with headless twin screw fixation tends to have better performance for its firmer fixation and shorter healing period,and it avoids the exposure of internal fixation material.