摘要
目的探讨踝关节骨折合并脱位急诊手术的效果及对患者踝关节功能的影响。方法选取2016年3月至2017年3月收治的踝关节骨折合并脱位患者56例,按手术的时限性分为两组,对照组使用择期手术治疗,研究组使用急诊手术治疗。治疗后6个月,对比两组患者治疗效果以及术后踝关节功能的影响。结果研究组总有效率略高于对照组,但差异无统计学意义(82.2%vs 64.3%,χ~2=2.276,P>0.05)。入院时,两组VAS评分、Barthel指数差异无统计学意义(P>0.05),术后6个月研究组VAS评分、Barthel指数显著优于对照组(P<0.01)。研究组手术时间[(94.7±15.3)min]、住院时间[(3.2±0.4)d]、骨折愈合时间[(9.4±1.1)周]显著短于对照组[(99.2±21.4)min、(5.8±1.2)d、(11.8±1.4)周,P<0.01],医疗费用[(18 225.2±1 636.3)元]显著少于对照组[(21 230.0±2 275.3)元,P<0.01]。结论在对踝关节骨折合并脱位患者的治疗中,急诊手术治疗的效果较为理想。
objective To investigate the effect of emergency operation on ankle fracture combined with dislocation and its effect on ankle joint function.Methods A total of 56 patients with ankle fracture and dislocation who underwent surgery from March 2016 to March 2017 were randomly divided into two groups.The control group received elective surgery and the study group received emergency surgery.After 6 monthes of treatment,the efficacy of the treatment and the effects of postoperative ankle joint function were compared between the two groups.Results The total effective rate of the study group was slightly higher than that of the control group,but the difference was not statistically significant(82.2% vs 64.3%,χ~2=2.276,P>0.05).At the time of admission,there was no significant difference in VAS score and Barthel index between the two groups(P>0.05).The VAS score and Barthel index of the study group were significantly better than those of the control group at 6 months after operation(P<0.01).The operation time [(94.7±15.3)min vs(99.2±21.4) min],hospitalization time [(3.2±0.4)d vs(5.8±1.2)d],fracture healing time [(9.4±1.1) weeks vs(11.8±1.4) weeks] of the study group was significantly shorter than those of the control group,medical expenses [(18 225.2±1 636.3) yuan vs(21 230±2 275.3) yuan] of the study group were significantly less than that of the control group(all P<0.01).Conclusion In the treatment of patients with ankle fracture and dislocation,the effect of emergency surgery is ideal.
引文
[1] 宋鹏,梁焕.LISS术联合中药熏洗对胫骨远端骨折术后踝关节功能恢复的影响[J].中华中医药学刊,2016,34(8):1971.
[2] Doherty C,Bleakley C,Hertel J,et al.Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability:A prospective cohort analysis[J].Am J Sports Med,2016,44(4):995-1003.
[3] 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Hawkins Ⅲ型距骨颈骨折[J].中华医学杂志,2016,96(41):3342-3346.
[4] 李岳伟,张茗慧,李小荣,等.弹性固定及坚强固定治疗踝关节旋前-外旋型骨折合并下胫腓联合分离的疗效比较[J].中国修复重建外科杂志,2017,31(7):820-824.
[5] He TW,Xiao WS,Zhang Y,et al.Effect of cooperative grain boundary sliding and migration on dislocation emission from a branched crack tip in deformed nanocrystalline solids[J].Int J Fract,2017,206(1):1-10.
[6] 宫良丰,李盛龙,齐志明,等.“Logsplitter”损伤的治疗方法与预后评价[J].中华骨科杂志,2016,36(14):881-890.
[7] Yu X,Li WL,Pang QJ,et al.Finite element analysis of locking plate and 1/4 tubular plate for first tarsometatarsal joint fracture-dislocation[J].J Int Med Res,2017,45(5):1528-1534.
[8] 张云,杨云峰.踝关节骨折合并急性三角韧带损伤的诊断和治疗进展[J].中国修复重建外科杂志,2017,31(5):624-628.
[9] 石维祥,罗晓中,吴刚,等.3D打印技术在内外踝尖部撕脱骨折治疗中的应用[J].中国修复重建外科杂志,2018,32(2):187-191.
[10] Tresley J,Subhawong TK,Singer AD,et al.Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination[J].Skeletal Radiol,2016,45(7):977-988.
[11] 庄颖峰,张旭鸣,许玮,等.后踝骨折的损伤机制及手术治疗结果分析[J].中国矫形外科杂志,2017,25(10):954-958.
[12] 邓艳斌,王齐兵,谭金波,等.急诊手术处理踝关节骨折脱位患者的临床效果[J].临床急诊杂志,2016,17(6):436-438.
[13] van Egmond PW,Vermeulen MC,van Dijke CF,et al.Superior dislocation of the patella:A pathognomonic finding and review of literature[J].Skeletal Radiol,2017,46(2):259-264.
[14] 车彪,王凯,刘俊,等.无骨折脱位的颈脊髓损伤急诊诊治中的若干认识[J].临床急诊杂志,2006,7(2):65-66.
