两种方法治疗伴后踝骨折的踝关节骨折疗效比较

摘要

目的 探讨两种方法治疗伴后踝骨折的踝关节骨折临床疗效.方法 对48例伴后踝骨折的踝关节骨折患者分别采用抗滑钢板固定后踝骨折块(A组)和空心钉固定后踝骨折块(B组)治疗.比较两组骨折愈合时间,采用AOFAS踝与后足功能评分系统评价术后疗效,比较两组术后6个月踝关节负重状态下的VAS评分和并发症发生率.结果 患者均获得随访,时间12~48个月.48例患者骨折端均解剖复位.术后2周及术后6个月的AOFAS评分:A组分别为(63.4±2.8)分、(84.5±4.3)分,B组分别为(62.9±3.1)分、(79.7±3.8)分;术后2周两组比较差异无统计学意义(P>0.05),术后6个月两组比较差异有统计学意义(P<0.05).骨折愈合时间:A组为(12.6±3.2)周,B组为(12.8±3.3)周,两组比较差异无统计学意义(P>0.05).术后6个月踝关节负重状态下的VAS评分:A组为(1.6±0.4)分,B组为(3.2±0.4)分,两组比较差异有统计学意义(P<0.05).A组并发症发生率为19.0%(4/21),其中创伤性关节炎发生率为9.5%(2/21);B组并发症发生率为48.1%(13/27),其中创伤性关节炎发生率为37.0%(10/27);并发症发生率和创伤性关节炎发生率两组比较差异均有统计学意义(P<0.05).结论 采用抗滑钢板固定后踝骨折块治疗伴后踝骨折的踝关节骨折更符合生物力学特性.%Objective To explore the clinical effect of two methods for ankle fractures with posterior malleolus fractures.Methods The 48 patients of ankle fractures with posterior malleolus fractures were treated by anti-slide plate or hollow screw fixation.The patients were divided into A group and B group.The following data were compared:fracture healing time, clinical effect according to AOFAS score system,ankle weight-bearing state VAS at 6 months postoperaiton and the complications incident rate.Results All 48 patients were followed up for 12~48 months and obtained satisfactory anatomical reduction.The A group′s AOFAS scores were 63.4±2.8 after 2 weeks and 84.5±4.3 after 6 months.The B group′s AOFAS scores were 62.9±3.1 after 2 weeks and 79.7±3.8 after 6 months.The differences were not significant in 2 weeks (P>0.05),while they were significant in 6 months(P<0.05).A group′s fracture healing time was (12.6±3.2)weeks.B group′s was (12.8±3.3) weeks,the differences were not significant(P>0.05).A group′s ankle weight-bearing state VAS was 1.6±0.4, B group′s was 3.2±0.4, the differences were significant(P<0.05).A group′s complication incidence rate was 19.0% (4/21) and the incidence rate of traumatic arthritis was 9.5%(2/21).B group′s complication rate was 48.1%(13/27)and the incidence rate of traumatic arthritis was 37.0%(10/27),the differences in complication incidence rate and the incidence rate of traumatic arthritis all had statistical significance(P<0.05).Conclusions For the treatment of ankle fractures with posterior malleolus fracture, the use of anti-slide plate fixation is more in line with the biomechanical properties.