内踝截骨入路无头加压螺钉内固定和空心加压螺钉治疗距骨颈骨折（HawkinsⅢ、Ⅳ型）对比研究
发布时间：2018-10-17 07:07
【摘要】：目 的 比较经内踝截骨入路采用无头加压螺钉和空心加压螺钉内固定治疗距骨颈骨折(Hawkins III、IV型)效果。方 法 自2013年3月至2015年3月在我院采用无头加压螺钉手术治疗的距骨颈骨折20例,其中男性12例,女性8例(实验组);采用空心加压螺钉治疗的距骨颈骨折患者21例,其中男性13例,女性8例(对照组)。以上患者均经内踝截骨入路行内固定治疗。记录患者的手术时间、出血量、住院天数、伤口愈合、骨折愈合情况、患肢功能(采用美国足踝外科协会踝与后足评分系统评价)以及距骨坏死等远期并发症的发生率,从而对采用这两种手术方法的疗效进行对比研究。结 果 全部病例均获得随访,随访时间1-2年,平均1.8年。实验组患者平均年龄为33.25±8.28岁(20-45岁)。实验组20例距骨颈骨折患者中,其中男性12例,女性8例,按照Hawkins分型,III型13例,IV型7例。患者平均手术时间为61.55±10.64分钟(45-87分钟),平均出血量为114.55±38.13ml(45-200ml),平均住院天数为10.60±2.30天(7-15天)。所有患者手术切口均获得一期愈合,所有骨折均获得愈合,但2例术后发生距骨缺血性坏死,坏死率为10%。按照美国足踝外科协会踝与后足评分系统(American Orthopaedic Foot and Ankle Society,AOFAS)评价,优10例,良8例,可2例,差0例。总体优良率为90%。对照组患者平均年龄为31.95±7.78岁(21-47岁)。21例距骨颈骨折患者中,其中男性13例,女性8例,按照Hawkins分型,III型12例,IV型9例。患者平均手术时间为61.90±6.02分钟(44-80分钟),平均出血量为112.19±20.74ml(50-180ml),平均住院天数为11.57±1.72天(8-16天)。所有患者手术切口均获得一期愈合,所有骨折均获得愈合,但8例术后发生距骨缺血性坏死,坏死率为38%。按照美国足踝外科协会踝与后足评分系统(American Orthopaedic Foot and Ankle Society,AOFAS)评价,优7例,良6例,可8例,差0例。总体优良率为62%。实验组和对照组患者在年龄和骨折类型方面没有统计学差异(P0.05),具有可比性。两组患者在手术时间、出血量和住院天数上均没有统计学差异(P0.05)。实验组患者的距骨坏死率(10%)低于对照组(38%),术后踝关节功能优良率(90%)大于对照组(62%)有统计学差异(P0.05)。结 论 经内踝截骨入路采用无头加压螺钉比空心加压螺钉内固定治疗距骨颈骨折的疗效更加确切,手术切口并发症发生率低,骨折愈合率高,距骨缺血坏死发生率低。
[Abstract]:Objective to compare the effect of head less compression screw and hollow compression screw in the treatment of talus neck fracture (Hawkins III,IV type) through medial malleolus osteotomy. From March 2013 to March 2015, 20 cases of talus neck fractures were treated with headless compression screws in our hospital, including 12 males and 8 females (experimental group), 21 patients with talus neck fractures treated with hollow compression screws. There were 13 males and 8 females (control group). All patients were treated with internal fixation via medial malleolus osteotomy. Time of operation, amount of blood loss, length of stay in hospital, wound healing, fracture healing, limb function (evaluated by the ankle and hind foot scoring system of the American Association of foot and ankle Surgeons) and the incidence of long term complications such as osteonecrosis of the talus were recorded. The results of the two methods were compared. All cases were followed up for 1-2 years (mean 1.8 years). The mean age of the patients in the experimental group was 33.25 卤8.28 (20-45 years). In the experimental group, 12 cases were male and 8 cases female. According to Hawkins classification, 13 cases of III type and 7 cases of IV type. The average operation time was 61.55 卤10.64 minutes (45-87 minutes), the average bleeding volume was 114.55 卤38.13ml (45-200ml), the average hospitalization time was 10.60 卤2.30 days (7-15 days). All the patients had primary healing of incision and all fractures were healed, but 2 cases had avascular necrosis of talus after operation, the necrosis rate was 10%. According to the ankle and hind foot scoring system (American Orthopaedic Foot and Ankle Society,AOFAS) of the American Association of ankle Surgeons, 10 cases were excellent, 8 cases were good, 2 cases were fair and 0 cases were poor. The overall excellent and good rate is 90%. The average age of the control group was 31.95 卤7.78 years (21-47 years). Among 21 cases of talus neck fracture, 13 cases were male and 8 cases were female. According to Hawkins classification, 12 cases of III type and 9 cases of IV type. The average operation time was 61.90 卤6.02 minutes (44-80 minutes), the average bleeding volume was 112.19 卤20.74ml (50-180ml), the average hospitalization time was 11.57 卤1.72 days (8-16 days). All the patients had primary healing of incision and all fractures were healed, but 8 cases had avascular necrosis of talus after operation, the necrosis rate was 38%. According to the ankle and hind foot scoring system (American Orthopaedic Foot and Ankle Society,AOFAS) of the American Association of ankle Surgeons, 7 cases were excellent, 6 cases were good, 8 cases were fair and 0 cases were poor. The overall excellent and good rate is 62. There was no significant difference in age and fracture type between the experimental group and the control group (P0.05), which was comparable. There was no significant difference in operation time, bleeding volume and hospital stay between the two groups (P0.05). The rate of osteonecrosis of talus in the experimental group (10%) was lower than that in the control group (38%). The excellent and good rate of ankle function in the experimental group (90%) was higher than that in the control group (62%) (P0.05). Conclusion the treatment of talus neck fracture with headless compression screw through medial malleolus osteotomy is more accurate than that with hollow compression screw. The complication rate of operative incision is lower, the rate of fracture healing is high, and the rate of avascular necrosis of talus is low.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
[Abstract]:Objective to compare the effect of head less compression screw and hollow compression screw in the treatment of talus neck fracture (Hawkins III,IV type) through medial malleolus osteotomy. From March 2013 to March 2015, 20 cases of talus neck fractures were treated with headless compression screws in our hospital, including 12 males and 8 females (experimental group), 21 patients with talus neck fractures treated with hollow compression screws. There were 13 males and 8 females (control group). All patients were treated with internal fixation via medial malleolus osteotomy. Time of operation, amount of blood loss, length of stay in hospital, wound healing, fracture healing, limb function (evaluated by the ankle and hind foot scoring system of the American Association of foot and ankle Surgeons) and the incidence of long term complications such as osteonecrosis of the talus were recorded. The results of the two methods were compared. All cases were followed up for 1-2 years (mean 1.8 years). The mean age of the patients in the experimental group was 33.25 卤8.28 (20-45 years). In the experimental group, 12 cases were male and 8 cases female. According to Hawkins classification, 13 cases of III type and 7 cases of IV type. The average operation time was 61.55 卤10.64 minutes (45-87 minutes), the average bleeding volume was 114.55 卤38.13ml (45-200ml), the average hospitalization time was 10.60 卤2.30 days (7-15 days). All the patients had primary healing of incision and all fractures were healed, but 2 cases had avascular necrosis of talus after operation, the necrosis rate was 10%. According to the ankle and hind foot scoring system (American Orthopaedic Foot and Ankle Society,AOFAS) of the American Association of ankle Surgeons, 10 cases were excellent, 8 cases were good, 2 cases were fair and 0 cases were poor. The overall excellent and good rate is 90%. The average age of the control group was 31.95 卤7.78 years (21-47 years). Among 21 cases of talus neck fracture, 13 cases were male and 8 cases were female. According to Hawkins classification, 12 cases of III type and 9 cases of IV type. The average operation time was 61.90 卤6.02 minutes (44-80 minutes), the average bleeding volume was 112.19 卤20.74ml (50-180ml), the average hospitalization time was 11.57 卤1.72 days (8-16 days). All the patients had primary healing of incision and all fractures were healed, but 8 cases had avascular necrosis of talus after operation, the necrosis rate was 38%. According to the ankle and hind foot scoring system (American Orthopaedic Foot and Ankle Society,AOFAS) of the American Association of ankle Surgeons, 7 cases were excellent, 6 cases were good, 8 cases were fair and 0 cases were poor. The overall excellent and good rate is 62. There was no significant difference in age and fracture type between the experimental group and the control group (P0.05), which was comparable. There was no significant difference in operation time, bleeding volume and hospital stay between the two groups (P0.05). The rate of osteonecrosis of talus in the experimental group (10%) was lower than that in the control group (38%). The excellent and good rate of ankle function in the experimental group (90%) was higher than that in the control group (62%) (P0.05). Conclusion the treatment of talus neck fracture with headless compression screw through medial malleolus osteotomy is more accurate than that with hollow compression screw. The complication rate of operative incision is lower, the rate of fracture healing is high, and the rate of avascular necrosis of talus is low.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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