踝关节骨折患者手术与保守疗法效果对比
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摘要
目的综合分析手术疗法(切开复位内固定术)与保守疗法(中医正骨手法复位石膏外固定术)在踝关节骨折(旋后外旋型—Lauge-Hansen分型)患者中的临床治疗效果及安全性。方法选取60例踝关节骨折患者按照不同的治疗方法分为观察组和对照组,各30例。分析2组踝关节的临床治疗效果。结果①观察组住院时间、关节功能恢复时间分别为(11. 38±5. 39) d、(55. 63±7. 85)周,均短于对照组的(17. 60±6. 18) d、(74. 43±8. 36)周,差异有统计学意义(P <0. 01),观察组骨折愈合时间与对照组比较,差异无统计学意义(P> 0. 05);观察组住院费用(16 058. 60±1 763. 25)元多于对照组(5 423. 68±443. 58)元,差异有统计学意义(P <0. 01)。②X线评定Ⅱ型患者2组比较差异无统计学意义(P> 0. 05),Ⅲ型、Ⅳ型患者数据比较差异有统计学意义(P <0. 05)。③2组Ⅱ型患者Mazur[(1979)踝关节评价分级系统]评分差异无统计学意义(P> 0. 05),观察组Ⅲ型、Ⅳ型Mazur评分高于对照组,差异有统计学意义(P <0. 05)。结论Ⅱ型踝关节骨科患者采取保守疗法效果较为理想,Ⅲ型和Ⅳ型踝关节骨折患者可采取手术疗法。
Objective To investigate the curative effect and safety of operative treatment( open reduction and internal fixation) and conservative treatment( traditional Chinese bone-setting and plaster external fixation) in patients with anklebone fracture( supination external rotation-Lauge-Hansen).Methods 60 cases of anklebone fracture were selected and divided into the observation group and the control group,30 cases in each group. Clinical therapeutic indexes of the two groups were analyzed.Results ①the hospitalization time and the recovery time of joint function in the observation group were( 11. 38 ± 5. 39) d,( 55. 63 ± 7. 85) weeks,which were respectively,shorter than those in the control group( 17. 60 ± 6. 18) d,( 74. 43 ± 8. 36) weeks. The difference was statistical significance( P <0. 01). The fracture healing time of the observation group was not significantly different from that of the control group( P > 0. 01). The hospitalization cost of the observation group was( 16 058. 60 ± 1 763. 25)yuan. It was far more than the control group( 5 423. 68 ± 443. 58) yuan. There was significant difference between the two groups( P < 0. 01). ②There was no statistical significance with the x-ray evaluation of type Ⅱ patients( P > 0. 05) but there was statistical significance with type Ⅲ and type Ⅳ patients( P >0. 05). 3. There was no significant difference in Mazur score between the two groups in II type patients( P > 0. 05). The Ⅲ and Ⅳ Mazur scores in the observation group [( 1979) ankle evaluation grading system) ]were significantly higher than those in the control group( P < 0. 01). Conclusion The effect of conservative therapy in patients with Ⅱ ankle joint is ideal,and that in patients with type Ⅲ and typeⅣ ankle joint is can be treated by surgical therpy. The effect of surgical treatment is more ideal.
Objective To investigate the curative effect and safety of operative treatment( open reduction and internal fixation) and conservative treatment( traditional Chinese bone-setting and plaster external fixation) in patients with anklebone fracture( supination external rotation-Lauge-Hansen).Methods 60 cases of anklebone fracture were selected and divided into the observation group and the control group,30 cases in each group. Clinical therapeutic indexes of the two groups were analyzed.Results ①the hospitalization time and the recovery time of joint function in the observation group were( 11. 38 ± 5. 39) d,( 55. 63 ± 7. 85) weeks,which were respectively,shorter than those in the control group( 17. 60 ± 6. 18) d,( 74. 43 ± 8. 36) weeks. The difference was statistical significance( P <0. 01). The fracture healing time of the observation group was not significantly different from that of the control group( P > 0. 01). The hospitalization cost of the observation group was( 16 058. 60 ± 1 763. 25)yuan. It was far more than the control group( 5 423. 68 ± 443. 58) yuan. There was significant difference between the two groups( P < 0. 01). ②There was no statistical significance with the x-ray evaluation of type Ⅱ patients( P > 0. 05) but there was statistical significance with type Ⅲ and type Ⅳ patients( P >0. 05). 3. There was no significant difference in Mazur score between the two groups in II type patients( P > 0. 05). The Ⅲ and Ⅳ Mazur scores in the observation group [( 1979) ankle evaluation grading system) ]were significantly higher than those in the control group( P < 0. 01). Conclusion The effect of conservative therapy in patients with Ⅱ ankle joint is ideal,and that in patients with type Ⅲ and typeⅣ ankle joint is can be treated by surgical therpy. The effect of surgical treatment is more ideal.
引文
[1]郭华,易林,张平安,等.踝关节骨折手术治疗和手法复位治疗对比分析[J].陕西医学杂志,2014,43(7):877-879.
[2]王涛,董建卓,赵海涛,等.保守疗法与手术疗法治疗旋后外旋型踝关节骨折临床疗效比较[J].河北医药,2015,37(8):1181-1183.
[3]何磊,敖永星,马海堂,等.保守疗法与手术疗法治疗旋后外旋型踝关节骨折临床疗效[J].当代医学,2015,21(23):82-83.
[4]吕肖峰,柳忠兴.保守治疗法与手术治疗旋后外旋型踝关节骨折疗效比较研究[J].吉林医学,2014,35(23):5103.
[5]杨威,敖传西,华贤章,等.非手术疗法和手术疗法治疗B2型踝关节骨折的对比研究[J].中医正骨,2013,25(4):15-17,22.
[6]王涛,董建卓,赵海涛,等.旋后外旋型踝关节骨折非手术与手术治疗效果对比分析[J].河北医药,2015,37(14):2141-2143.
[7]何翔,邢顺民.关节固定制动法治疗踝关节韧带损伤的临床效果观察[J].现代诊断与治疗,2015,16(23):5434-5435.
[8]姜矞恒,李莹,王岩.踝关节骨折畸形愈合的诊断与治疗研究进展[J].中华创伤骨科杂志,2017,19(3):268-271.
[9]张鹏,董启榕,王宗允,等.内、外侧双切口结合Herbert螺钉内固定治疗合并同侧踝关节骨折的HawkinsⅢ型距骨颈骨折[J].中华医学杂志,2016,96(41):3342-3346.
[10]马腾,王谦,路遥,等.非刚性与传统螺钉内固定治疗踝关节骨折伴下胫腓联合损伤的疗效比较[J].中华创伤杂志,2016,32(8):677-682.
[11]吴若丹,郭斌,陈成礼,等.25例胫骨Pilon骨折治疗分析[J].河南医学高等专科学校学报,2009,21(2):144-145.
[12]王波,王天文,武亚娟.保守疗法与手术疗法在踝关节骨折患者的疗效比较[J].江苏医药,2017,43(14):1011-1013.
[13]杨幸山,樊丽丽.关节镜手术与非手术保守治疗踝关节退行性骨关节病疗效比较[J].海南医学,2017,28(3):478-479.
[14]CASTAGNINI F,PELLEGRINI C,PERAZZO L,et al.Joint sparing treatments in early ankle osteoarthritis:current procedures and future perspectives[J].J Exp Orthop,2016,3(1):1-7.
[2]王涛,董建卓,赵海涛,等.保守疗法与手术疗法治疗旋后外旋型踝关节骨折临床疗效比较[J].河北医药,2015,37(8):1181-1183.
[3]何磊,敖永星,马海堂,等.保守疗法与手术疗法治疗旋后外旋型踝关节骨折临床疗效[J].当代医学,2015,21(23):82-83.
[4]吕肖峰,柳忠兴.保守治疗法与手术治疗旋后外旋型踝关节骨折疗效比较研究[J].吉林医学,2014,35(23):5103.
[5]杨威,敖传西,华贤章,等.非手术疗法和手术疗法治疗B2型踝关节骨折的对比研究[J].中医正骨,2013,25(4):15-17,22.
[6]王涛,董建卓,赵海涛,等.旋后外旋型踝关节骨折非手术与手术治疗效果对比分析[J].河北医药,2015,37(14):2141-2143.
[7]何翔,邢顺民.关节固定制动法治疗踝关节韧带损伤的临床效果观察[J].现代诊断与治疗,2015,16(23):5434-5435.
[8]姜矞恒,李莹,王岩.踝关节骨折畸形愈合的诊断与治疗研究进展[J].中华创伤骨科杂志,2017,19(3):268-271.
[9]张鹏,董启榕,王宗允,等.内、外侧双切口结合Herbert螺钉内固定治疗合并同侧踝关节骨折的HawkinsⅢ型距骨颈骨折[J].中华医学杂志,2016,96(41):3342-3346.
[10]马腾,王谦,路遥,等.非刚性与传统螺钉内固定治疗踝关节骨折伴下胫腓联合损伤的疗效比较[J].中华创伤杂志,2016,32(8):677-682.
[11]吴若丹,郭斌,陈成礼,等.25例胫骨Pilon骨折治疗分析[J].河南医学高等专科学校学报,2009,21(2):144-145.
[12]王波,王天文,武亚娟.保守疗法与手术疗法在踝关节骨折患者的疗效比较[J].江苏医药,2017,43(14):1011-1013.
[13]杨幸山,樊丽丽.关节镜手术与非手术保守治疗踝关节退行性骨关节病疗效比较[J].海南医学,2017,28(3):478-479.
[14]CASTAGNINI F,PELLEGRINI C,PERAZZO L,et al.Joint sparing treatments in early ankle osteoarthritis:current procedures and future perspectives[J].J Exp Orthop,2016,3(1):1-7.