拉力钉与支撑钢板固定Haraguchi Ⅰ型后踝骨折比较
Posterior-anterior lag screw versus buttress plate for fixation of Haraguchi type Ⅰ posterior malleolus fractures
许宏斌 1杨学锋 1蒋宜伟 1徐克武 1强胜林 1贾永龙 1黄凯 1陈海 1张德胤1
作者信息
- 1. 甘肃中医药大学附属医院骨科,甘肃兰州 730020
- 折叠
摘要
[目的]比较后前拉力螺钉与支撑钢板治疗Haraguchi Ⅰ型后踝骨折的临床效果.[方法]回顾性分析2020年6月-2022年9月开放复位内定治疗Haraguchi Ⅰ型后踝骨折80例患者的临床资料.根据医患沟通结果,38例采用后前拉力螺钉固定后踝(螺钉组),另外42例采用支撑钢固定后踝(钢板组),同时间处理合并的外踝和内踝骨折.比较两组围术期、随访及影像学资料.[结果]螺钉组在手术时间[(69.5±4.6)min vs(90.2±6.4)min,P＜0.001]、切口总长度[(9.0±2.3)cm vs(10.3±2.6)cm,P=0.021]、术中失血量[(104.8±20.5)ml vs(116.0±21.3)ml,P=0.019]均显著少于钢板组,但螺钉组下地行走时间[(64.8±3.7)d vs(60.0±4.0)d,P=0.019]显著晚于钢板组,两组完全负重活动时间的差异无统计学意义(P＞0.05).与术后3个月相比,末次随访时,两组VAS、AOFAS评分及背伸-跖屈ROM均显著改善(P＜0.05).术后3个月,螺钉组AOFAS评分[(83.6±4.9)vs(86.0±5.5),P=0.044]显著低于钢板组,两组VAS评分及踝背伸-跖屈ROM的差异均无统计学意义(P＞0.05);末次随访时,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、骨折愈合时间比较的差异均无统计学意义(P＞0.05).[结论]后前拉力螺钉与支撑钢板治疗Haraguchi Ⅰ型后踝骨折的复位质量、功能改善相当,后者相对手术时间长、术中出血量多,但其下地行走时间早.
Abstract
[Objective]To compare the clinical outcomes of posterior-anterior lag screw versus buttress plate for fixation of Haraguchi type Ⅰ posterior malleolus fractures.[Methods]A retrospective analysis was performed on 80 patients who received open reduction and in-ternal fixation(ORIF)for Haraguchi type Ⅰ posterior malleolus fractures from June 2020 to September 2022.According to the doctor-pa-tient communication,38 case had the posterior malleolus fractures fixed with the posterior-anterior lag screw(the screw group).while other 42 cases were fixed with buttress plate(the plate group),with the combined lateral and medial malleolar fractures treated simultaneously.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The screw group was significantly less than the plate group in terms of operative time[(69.5±4.6)min vs(90.2±6.4)min,P＜0.001],total incision length[(9.0±2.3)cm vs(10.3±2.6)cm,P=0.021]and intraoperative blood loss[(104.8±20.5)ml vs(116.0±21.3)ml,P=0.019],although the former resumed postoperative walking sig-nificantly later than the latter[(64.8±3.7)days vs(60.0±4.0)days,P=0.019].There was no statistically significant difference in time to re-gain the full weight-bearing activity between the two groups(P＞0.05).Compared with those 3 months after surgery,the VAS,AOFAS scores and dorsal-plantar flexion ROM in both groups were significantly improved at the last follow-up(P＜0.05).The screw group got sig-nificantly lower AOFAS score than the plate group 3 months after surgery[(83.6±4.9)vs(86.0±5.5),P=0.044],whereas there were no signifi-cant differences in VAS score and ankle-dorsal-plantar flexion ROM between the two groups(P＞0.05).At the last follow-up,there was no significant difference between the two groups in terms of any items abovementioned(P＞0.05).As for imaging,there were no significant dif-ferences in the quality of fracture reduction and healing time between the two groups(P＞0.05).[Conclusion]Both posterior-anterior lag screw and buttress plate achieve comparable clinical consequences for fixation of Haraguchi type Ⅰ posterior malleolus fractures.By compar-ison,the screw has shorter operation time and less intraoperative bleeding,but longer time to resume walking.
关键词
Haraguchi/Ⅰ型后踝骨折/后前拉力螺钉/支撑钢板/临床疗效Key words
Haraguchi type Ⅰ posterior malleolus fractures/posterior-anterior lag screw/buttress plate/clinical outcome引用本文复制引用
基金项目
甘肃省自然科学基金项目(22JR5RA612)
出版年
2024
NETL
NSTL
万方数据