空心钉与支撑钢板固定后踝骨折块的比较
Cannulated screws versus support plate for fixation of posterior malleolus fracture fragment
魏建军 1颜世昌 1杨永江 1杨丰真 1田纪伟1
作者信息
- 1. 南京医科大学附属明基医院骨科,江苏南京 210019
- 折叠
摘要
[目的]比较空心钉固定和支撑钢板固定三踝骨折和后踝骨折块的临床疗效.[方法]回顾性分析2018年2月-2021年2月68例三踝骨折患者的临床资料.根据医患沟通结果,41例采用空心钉固定后踝骨块,另外27例采用支撑钢板固定.比较两组围手术期指标、随访及影像资料.[结果]两组手术时间、切口长度、术中出血量、术中透视次数、切口愈合等级、住院时间、下地行走时间、切口感染、血管栓塞事件的差异均无统计学意义(P＞0.05).空心钉组的趾屈曲挛缩[例(％),2(4.9)vs 7(25.9),P=0.012]及内置物激惹[例(％),3(7.3)vs 11(40.7),P＜0.001]的发生率显著优于支撑板组.与术后3个月相比,末次随访时,两组VAS评分、AOFAS评分及踝背伸/跖屈ROM均显著改善(P＜0.05).相应时间点,两组上述指标的差异均无统计学意义(P＞0.05).影像方面,两组骨折复位质量、骨愈合、创伤性关节炎发生情况的差异均无统计学意义(P＞0.05).与术前相比,末次随访时,两组TFCS、MCS均显著减小(P＜0.05),相应时间点,两组间TFCS、MCS的差异均无统计学意义(P＞0.05).[结论]空心钉和支撑钢板均可有效固定后踝骨折块,获得满意的踝关节功能,但需随访创伤后关节炎的进展.与支撑钢板固定相比,空心钉固定操作更简单有效,内置物相关并发症更少.
Abstract
[Objective]To compare the clinical efficacy of cannulated screw fixation versus support plate fixation of the posterior malle-olar fracture fragment in the trimalleolar fractures.[Methods]A retrospective study was done on 68 patients who received surgical treat-ment for trimalleolar fractures from February 2018 to February 2021.According to the surgeon-patient communication,41 patients had the posterior malleolus fragment fixed with cannulated screws(CS),while the other 27 patients were fixed with support plates(SP).The data re-garding to perioperative period,follow-up and images were compared between the two groups.[Results]There were no significant differenc-es in terms of operation time,incision length,intraoperative blood loss,intraoperative fluoroscopy times,incision healing grade,hospital stay,walking time,occurrences of incision infection and thrombosis events between the two groups(P＞0.05).However,the CS group proved significantly superior to the SP group in terms of incidence of toe flexion contracture[case(％),2(4.9)vs 7(25.9),P=0.012]and implant irri-tation[case(％),3(7.3)vs 11(40.7),P＜0.001].Compared with those 3 months after surgery,the VAS score,AOFAS score and ankle-dorsi-flexion/plantar flexion ROM in both groups were significantly improved at the last follow-up(P＜0.05),whereas which were not statistically significant at any corresponding time points between the two groups(P＞0.05).Radiographically,there were no statistically significant differ-ences in the quality of fracture reduction,bone healing and traumatic arthritis between the two groups(P＞0.05).The tibiofibular clear space(TFCS)and medial clear space(MCS)in both groups were significantly decreased at the last follow-up compared with those preoperatively(P＞0.05),while there were no significant differences in TFCS and MCS between the two groups at corresponding time points(P＞0.05).[Conclusion]Both cannulated screws and support plates do effectively fix posterior malleolus fracture,and achieve satisfactory clinical con-sequences,despite that the progression of post-traumatic arthritis needs to be furtherly followed up.Compared with support plate fixation,cannulated screw fixation is simpler and more effective,with fewer implant-related complications.
关键词
三踝骨折/后踝骨折/开放复位内固定/空心钉/钢板Key words
trimalleolar fractures/posterior malleolus fracture/open reduction and internal fixation/cannulated screw/plate引用本文复制引用
出版年
2024
NETL
NSTL
万方数据