手法整复外固定术与切开复位内固定治疗B型踝关节骨折的早期临床效果比较
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摘要
目的对比分析手法整复外固定术和切开复位内固定术治疗B型踝关节骨折早期临床效果,探讨其临床适用性。方法选择从2014年3月至2015年10月于我院接诊的68例B型踝关节骨折患者,按照随机数字表,随机抽取试验组34例和对照组34例,对照组患者全部采用切开复位内固定术治疗,试验组患者则进行手法整复外固定术治疗。观察两组患者的骨折复位情况,两组患者术后的肿胀消退时间和住院时间,分析患者的骨折愈合时间及踝关节功能活动评分情况。结果两种治疗方法在B1型和B2型的踝关节骨折分型中的治疗优良率均无显著差异(P>0.05),对于B3型踝关节骨折中,对照组患者的优良率92.3%,显著高于试验组患者的治疗优良率58.3%,差异有统计学意义(P<0.05),两组患者骨折治疗后肿胀消退时间比较,差异无统计学意义(P>0.05);但对照组患者平均住院时间比试验组患者长,差异有统计学意义(P<0.05)。随访两组患者各骨折分组类型的骨折愈合时间比较,差异无统计学意义(P>0.05)。两种复位方法对B1型和B2型踝关节骨折分型术后的踝关节功能评分AOFAS各项分值中比较,差异无统计学意义(P>0.05),在B3型踝关节骨折中,对照组患者的AOFAS评分优于试验组患者,差异均有统计学意义(P<0.05)。结论手法整复外固定术和切开复位内固定术治疗B1型和B2型的踝关节骨折方面在术后疗效方面无显著差异,但手术内固定术在治疗B3型的踝关节骨折中更加有效,术后的踝关节功能评分显著获益。
Objective To compare the early clinical effects of manipulation external fixation and internal fixation for the treatment of type B ankle fractures. Methods 68 patients with type B ankle fractures were selected from March 2014 to October 2015 in our hospital. According to the random number table,all the 68 cases were randomly divided into the experimental group and the control group,with 34 for each. The control group received internal fixations,while the experimental group received manipulative external fixations. Results There was no significant difference between the two groups in the excellent rates of the B1 and B2 types of ankle fractures patients(P>0.05). But in the B3 ankle fractures,the excellent rate of the control group was 92.3%,which was significantly higher than 58.3% of the experimental group(P<0.05). There was no significant difference of swelling time(P>0.05),but hospital stay of the control group was longer(P< 0.05). Fracture healing time and the AOFAS scores of B1 and B2 type ankle fractures had no difference(P > 0. 05).
But in the B3 ankle fractures,the AOFAS score of the control group was better than that of the experimental group(P<0.05).ConclusionsThe manipulation external fixation and the internal fixation for the treatment of type B1 and B2 type of ankle fractures are both effective,but the internal fixation is more effective in the treatment of type B3 ankle fractures and the postoperative the ankle joint function scores significantly benefited.
Objective To compare the early clinical effects of manipulation external fixation and internal fixation for the treatment of type B ankle fractures. Methods 68 patients with type B ankle fractures were selected from March 2014 to October 2015 in our hospital. According to the random number table,all the 68 cases were randomly divided into the experimental group and the control group,with 34 for each. The control group received internal fixations,while the experimental group received manipulative external fixations. Results There was no significant difference between the two groups in the excellent rates of the B1 and B2 types of ankle fractures patients(P>0.05). But in the B3 ankle fractures,the excellent rate of the control group was 92.3%,which was significantly higher than 58.3% of the experimental group(P<0.05). There was no significant difference of swelling time(P>0.05),but hospital stay of the control group was longer(P< 0.05). Fracture healing time and the AOFAS scores of B1 and B2 type ankle fractures had no difference(P > 0. 05).
But in the B3 ankle fractures,the AOFAS score of the control group was better than that of the experimental group(P<0.05).ConclusionsThe manipulation external fixation and the internal fixation for the treatment of type B1 and B2 type of ankle fractures are both effective,but the internal fixation is more effective in the treatment of type B3 ankle fractures and the postoperative the ankle joint function scores significantly benefited.
引文
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[4]Leeds HC,Ehrlich MG.Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures[J].J Bone Joint Surg Am,1984,66(4):490-503.
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[7]鹿军,孙川,梁晓军,等.低切迹后外侧接骨板内固定治疗Danis-Weber B型腓骨骨折的临床观察[J].中国骨与关节损伤杂志,2013,28(10):975-976.
[8]周一飞,余洋,张小磊,等.手术与手法复位治疗踝关节骨折的临床疗效分析[J].中国骨伤,2012,25(5):404-406.
[9]任警,黄晓峰,陈强,等.踝关节骨折外踝畸形愈合的重建手术[J].中国骨与关节损伤杂志,2012,27(10):950-951.
[10]Hinds RM,Lazaro LE,Burket JC,et al.Risk factors for posttraumatic synostosis and outcomes following operative treatment of anklefractures[J].Foot Ankle Int,2014,35(2):141-147.doi:10.1177/1071100713510913.28.
[11]李顺达.切开复位内固定手术与保守治疗在不稳定型踝关节骨折中的应用效果对比[J].浙江创伤外科,2016,21(3):457-458,459.
[2]孙继飞,刘振利,刘晓伟,等.俯卧位手术治疗三踝骨折合并下胫腓联合分离[J].中国现代手术学杂志,2010,14(3):203-205.
[3]陈雁西.踝关节骨折分型及特殊类型骨折治疗方法[J].中华创伤杂志,2015,31(2):104-106.
[4]Leeds HC,Ehrlich MG.Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures[J].J Bone Joint Surg Am,1984,66(4):490-503.
[5]Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[6]邓锋.Denis-Weber B型踝关节骨折手法整复外固定与手术内固定的早期临床疗效观察[D].云南中医学院,2015.
[7]鹿军,孙川,梁晓军,等.低切迹后外侧接骨板内固定治疗Danis-Weber B型腓骨骨折的临床观察[J].中国骨与关节损伤杂志,2013,28(10):975-976.
[8]周一飞,余洋,张小磊,等.手术与手法复位治疗踝关节骨折的临床疗效分析[J].中国骨伤,2012,25(5):404-406.
[9]任警,黄晓峰,陈强,等.踝关节骨折外踝畸形愈合的重建手术[J].中国骨与关节损伤杂志,2012,27(10):950-951.
[10]Hinds RM,Lazaro LE,Burket JC,et al.Risk factors for posttraumatic synostosis and outcomes following operative treatment of anklefractures[J].Foot Ankle Int,2014,35(2):141-147.doi:10.1177/1071100713510913.28.
[11]李顺达.切开复位内固定手术与保守治疗在不稳定型踝关节骨折中的应用效果对比[J].浙江创伤外科,2016,21(3):457-458,459.