摘要
目的:探讨不同固定方案对三踝骨折患者术后近远期下肢功能的影响。方法:回顾性分析84例三踝骨折患者的临床资料,根据其后踝骨折固定方案将患者分为钢板固定组(n=45)与空心螺钉固定组(n=39),比较两组患者手术指标(手术时间、术中出血量、术后住院时间)、术前与术后早期踝关节跖屈和背伸角度、疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分。所有患者术后随访12个月,比较其后踝愈合时间及术后6、12个月的AOFAS踝-后足评分。结果:钢板固定组手术时间长于空心螺钉固定组(P<0.05),两组术中出血量、术后住院时间差异均无统计学意义(P>0.05)。术后1个月,两组踝关节跖屈和背伸角度均增大(P<0.05),且钢板固定组大于空心螺钉固定组(P<0.05);两组疼痛VAS评分均降低(P<0.05),且钢板固定组低于空心螺钉固定组(P<0.05);两组AOFAS踝-后足评分均升高(P<0.05),且钢板固定组高于空心螺钉固定组(P<0.05)。两组术后近期治疗优良率无统计学差异(P>0.05)。两组后踝愈合时间及术后6、12个月AOFAS踝-后足评分无统计学差异(P>0.05)。结论:相对于空心螺钉固定,钢板固定更有利于三踝骨折患者术后早期踝关节功能恢复,两种固定方式对下肢功能的远期影响无显著差异。
Objective:To explore the effects of different fixation methods on the short-and long-term lower limb function in patients with trimalleolar fractures.Methods:A retrospective analysis was conducted on clinical data from 84 patients with trimalleolar fractures patients were divided into two groups based on their posterior malleolus fracture fixation method:a plate fixation group(n=45) and a cannulated screw fixation group(n=39).Surgical indicators(operation time,intraoperative blood loss,postoperative hospital stay),preoperative and early postoperative ankle plantarflexion and dorsiflexion angles,Visual Analogue Scale(VAS) pain scores,and American Orthopaedic Foot & Ankle Society(AOFAS) Ankle-Hindfoot Scores were compared between the two groups.All patients underwent follow-up for 12 months after surgery to compare the time to posterior malleolus union and AOFAS Ankle-Hindfoot Scores at 6 and 12 months postoperatively.Results:The operation time was longer in the plate fixation group compared to the cannulated screw fixation group(P<0.05).There were no significant differences between the two groups in terms of intraoperative blood loss and postoperative hospital stay(P>0.05).1 month postoperatively,both groups showed increased ankle plantarflexion and dorsiflexion angles,with the plate fixation group having larger angles than the cannulated screw fixation group(P<0.05).At 1 month postoperatively,both groups had reduced pain Visual Analogue Scale(VAS) scores and increased American Orthopaedic Foot & Ankle Society(AOFAS) Ankle-Hindfoot Scores(P<0.05),with the plate fixation group showing greater changes in both VAS scores and AOFAS Ankle-Hindfoot Scores compared to the cannulated screw fixation group(P<0.05).There was no significant difference in the short-term treatment success rate between the two groups(P>0.05).The time to posterior malleolus union and AOFAS Ankle-Hindfoot Scores at 6 and 12 months postoperatively did not differ significantly between the plate fixation group and the cannulated screw fixation group(P>0.05).Conclusion:Compared to cannulated screw fixation,plate fixation is more beneficial for early postoperative recovery of ankle function in patients with trimalleolar fractures.However,there are no significant differences between the two fixation methods in terms of long-term lower limb function.
作者
张立
刑润麟
梅伟
ZHANG Li;XING Run-lin;MEI Wei(Department of Orthopedics and Traumatology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210000,Jiangsu,China)
出处
《川北医学院学报》
2025年第3期302-305,共4页
Journal of North Sichuan Medical College
基金
江苏省医学重点学科·实验室建设单位项目(JSDW202252)。
关键词
三踝骨折
后踝钢板固定
空心螺钉固定
下肢功能
Trimalleolar fracture
Posterior malleolus plate fixation
Cannulated screw fixation
Lower limb function
