两种手术入路治疗距骨颈骨折的临床疗效观察

发布时间：2018-03-24 22:35

本文选题：距骨颈骨折　切入点：前内侧切口入路　出处：《苏州大学》2015年硕士论文

【摘要】：一、研究目的回顾性观察比较两种手术入路(单侧前内侧切口入路和双侧切口入路)治疗距骨颈骨折的临床疗效。二、研究方法2006年6月至2013年9月,共36例距骨颈骨折患者在常州市中医院就诊,其中随访资料完整的手术患者31例,分别采用了单侧前内侧切口入路和双侧切口入路。根据其手术入路分成两组:单切口组(15例)、双切口组(16例)。运用统计学方法计算并比较两组患者术后一年骨折的愈合率、创伤性关节炎和距骨缺血性坏死的发生率、Hawkins疗效评定优良率、VAS评分及AOFAS踝-后足评分。三、研究结果术后一年31例患者总体骨折愈合率为77.42%,其中单切口组为93.33%,双切口组为62.50%。两组患者在骨折愈合率方面有统计学差异(P0.05)。31例患者术后一年创伤性关节炎的发生率为29.03%,其中单切口组为46.67%,双切口组为12.50%。单切口组创伤性关节炎的发生率高于双切口组,差异有统计学意义(P0.05)。31例患者术后一年距骨缺血性坏死的发生率为16.13%,其中单切口组为13.33%,双切口组为18.75%,两组患者在距骨缺血性坏死的发生率方面无统计学差异(P0.05)。31例患者术后一年Hawkins疗效评定总体优良率为61.29%,其中单切口组为51.33%,双切口组为68.75%,两组患者的优良率无统计学差异(P0.05)。术后一年,单切口组VAS评分为6.04±0.75,AOFAS评分为42.84±10.16;双切口组VAS评分为为3.28±0.42,AOFAS评分为61.24±11.8;单切口组VAS评分高于双切口组,AOFAS评分低于双切口组,差异有统计学意义(P0.05)。四、研究结论单侧前内切口入路治疗距骨颈骨折术后一年的骨折愈合率高于双侧切口入路,而创伤性关节炎的发生率较双侧切口入路高。单侧前内切口入路和双侧切口入路治疗距骨颈骨折术后一年AVN的发生率及Hawkins疗效评定优良率无明显差异,而单侧前内切口入路术后一年的VAS评分略高于双侧切口入路,术后一年的AOFAS评分略低于双侧切口组。两种手术入路各有优缺点,应根据术前资料及术中所见灵活选择。
[Abstract]:Objective: to retrospectively observe and compare the clinical efficacy of two surgical approaches (unilateral anterior medial incision and bilateral incision approach) in the treatment of talus neck fractures. A total of 36 patients with fracture of talus neck were treated in Changzhou Hospital of traditional Chinese Medicine. Unilateral anteromedial incision approach and bilateral incision approach were used respectively. According to the surgical approach, the patients were divided into two groups: single incision group (n = 15) and double incision group (n = 16). The rate of fracture healing in two groups was calculated and compared by statistical method. The incidence of traumatic arthritis and avascular necrosis of talus. Results the overall fracture healing rate of 31 patients one year after operation was 77.42, including 93.33 in the single incision group and 62.50 in the double incision group. There was a significant difference in fracture healing rate between the two groups (P 0.05). 31 cases of traumatic arthritis occurred one year after operation. The incidence of traumatic arthritis in the single incision group was higher than that in the double incision group. The incidence of avascular necrosis of talus was 16.13 in one year after operation, including 13.33 in the single incision group and 18.75 in the double incision group. There was no significant difference in the incidence of avascular necrosis of the talus between the two groups (P 0.05). The total excellent and good rate of Hawkins one year after operation was 61.29, including 51.33 in the single incision group and 68.75 in the double incision group. There was no significant difference in the excellent and good rates between the two groups (P 0.05). The VAS score of single incision group was 6.04 卤0.75 VAS score was 42.84 卤10.16, the VAS score of double incision group was 3.28 卤0.42 VAS score was 61.24 卤11.8.The VAS score of single incision group was higher than that of double incision group, and the difference was significant (P 0.05). Conclusion the fracture healing rate of unilateral anterior internal incision approach is higher than that of bilateral incision approach one year after the treatment of talus neck fracture. However, the incidence of traumatic arthritis was higher than that of bilateral incision approach. There was no significant difference in the incidence of AVN and the excellent and good rate of Hawkins evaluation between unilateral anterior incision approach and bilateral incision approach in the treatment of talus neck fracture one year after operation. The VAS score of unilateral anterior internal incision was slightly higher than that of bilateral incision one year after operation, and the AOFAS score of one year after operation was slightly lower than that of bilateral incision group.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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