后踝不同大小骨块手术与保守治疗临床疗效分析

发布时间：2018-11-07 13:30

【摘要】：目的:通过对比保守与手术治疗后踝骨折的预后指标,探讨不同大小骨块后踝骨折最佳治疗策略,以期达到满意的临床预后标准,取得更好远期疗效。方法:回顾性分析对比大连医科大学附属第二医院2011年8月至2014年8月期间,累及后踝的单侧闭合性踝关节骨折75例。分为手术与保守治疗两组。其中手术治疗组,男性:14人,女性:22人;左、右踝:14、22例;年龄(均数±标准差):46.50±16.20岁,根据后踝骨块大小分为(I:骨块累及关节面25%,骨块移位2mm。II:骨块累及关节面25%,骨块移位2mm)。其中I:10人、II:26人;受伤方式:高处坠落伤11人、交通意外6人、扭伤19人。保守治疗组,男性:19人,女性:20人;左、右踝:15、24例;年龄(均数±标准差):49.50±15.8岁;I:25人、II:14人;受伤方式:高处坠落伤10人、交通意外7人、扭伤22人。AO(B型):38人;AO(C型):37人。比较两组患者年龄、性别、受伤方式、骨折分型,无差异(P0.05)。从而选用(AOFAS)美国踝-后足评分系统对比两组患者踝关节功能及治愈率,通过影像学资料比较两组患者骨折愈合时间并记录末次随访时踝关节X线片的关节平整度。结果:患者平均随访16个月(6-26),失访3人,其中2例患者外踝切口周围皮肤发红,经涂抹外用抗生素、换药等处置后切口愈合,1例患者外踝侧切口愈合欠佳,经按时换、油纱覆盖后切口完全愈合,余两组患者术后均无骨折不愈合、延迟愈合、断钉等情况。当后踝骨块小于25%关节面时,手术治疗组(10例)踝-后足评分:92.70±6.88,优、良、可、差(6、3、1、0),优良率90%;保守治疗组(25例)踝-后足评分:91.48±7.11,优、良、可、差(15、7、3、0),优良率88%,经统计学分析,两组无差异(P0.05)。但当骨块大于25%关节面时,手术治疗组(26例)踝-后足评分:89.25±7.15,优、良、可、差(14、8、3、1),优良率84.6%;保守治疗组(14例)AOFAS评分:76.78±8.29,优、良、可、差(4、6、2、2),优良率71.4%,经计算数据有差异(P0.05)。骨折愈合时间:手术组(11.4±1.2W),保守组(12.9±1.6W)统计学有差异(P0.05)。共随访的75例患者中,2人出现重度关节退变7人出现不同程度的轻中度关节退变,余患者末次随访时踝关节X线平整度正常。结论:踝关节骨折中,当后踝骨块累及关节面25%、骨块移位2mm时,有效的内固定明显优于保守治疗。当距骨后脱位、骨块移位明显或伴有下胫腓联合分离时,即使骨块累及关节面25%,也应手术固定。对后踝撕脱骨折或移位不明显2mm、骨块较小25%时,可复位后保守治疗。胫前微创空心螺钉技术对后踝骨折的治疗可取得满意的临床效果。
[Abstract]:Objective: to compare the prognostic indexes of ankle fracture after conservative and surgical treatment and to explore the best treatment strategy of ankle fracture with different size of bone mass in order to achieve satisfactory clinical prognostic standard and obtain better long-term curative effect. Methods: 75 cases of unilateral closed ankle fractures involving posterior malleolus in the second affiliated Hospital of Dalian Medical University from August 2011 to August 2014 were retrospectively analyzed and compared. The patients were divided into two groups: operation group and conservative treatment group. In the surgical treatment group, 14 cases were male, 22 cases were female, and 14 cases were left and right ankle. Age (mean 卤standard deviation): 46.50 卤16.20 years old. According to the size of posterior malleolar bone, it was divided into two parts (I: bone mass involving articular surface 25 mm. II: bone mass displacement 2 mm. II: bone mass involving articular surface 25, bone mass shifting 2mm). Among them, I: 10, II:26; injuries: 11 people fall, 6 traffic accidents, 19 sprain. Conservative treatment group (male: 19, female: 20; left, right ankle: 15; age (mean 卤standard deviation): 49.50 卤15.8; I: 25, II:14; Injury pattern: fall injury 10, traffic accident 7, sprain 22. AO (B): 38; AO (C): 37. There was no difference in age, sex, injury style, fracture classification between the two groups (P0.05). The ankle function and cure rate of the two groups were compared by (AOFAS) American ankle-hind foot scoring system. The fracture healing time of the two groups was compared by imaging data and the joint smoothness of the ankle X-ray film at the last follow-up was recorded. Results: the patients were followed up for an average of 16 months (6-26), 3 of them were not interviewed. The skin around the lateral malleolus incision was redness in 2 patients, the incision healed after applying antibiotics and dressing change, and one patient had poor lateral malleolus incision healing. After changing on time, the incision healed completely after covering with oil gauze, the other two groups had no fracture nonunion, delayed healing, broken nail and so on. When the posterior malleolar mass was less than 25% of the articular surface, the ankle-hind foot score of the surgical treatment group (10 cases) was 92.70 卤6.88, excellent, good, fair and poor (6). The excellent and good rate was 90. In the conservative treatment group (25 cases), the ankle-hind foot score was 91.48 卤7.11, excellent, good, fair and poor (157f3 / 0). The excellent and good rate was 880.There was no difference between the two groups (P0.05). But when the bone mass was more than 25%, the ankle-hind foot score of the surgical treatment group (26 cases) was 89.25 卤7.15, excellent, good, fair and poor (14). The excellent and good rate was 84.6%. In the conservative treatment group (14 cases), the AOFAS score was 76.78 卤8.29, excellent, good, fair and poor (40.66% 2P 2), and the excellent and good rate was 71.4% (P0.05). Fracture healing time: operation group (11.4 卤1.2 W), conservative group (12.9 卤1.6 W) statistical difference (P0.05). Of the 75 cases followed up, 2 had severe degenerative joint and 7 had mild to moderate joint degeneration, and the rest had normal X-ray of ankle joint at the last follow-up. Conclusion: in ankle fracture, the effective internal fixation is superior to conservative treatment when the posterior malleolar mass involves the articular surface 25 and the bone mass shifts 2mm. When the dislocation of posterior talus is obvious or accompanied by the separation of inferior tibiofibular syndesmosis, the bone mass should be fixed surgically even if it involves 25% of the articular surface. When the posterior malleolus avulsion fracture or displacement is not obvious 2 mm and the bone mass is smaller than 25 mm, the posterior malleolus can be reduced and treated conservatively. The treatment of posterior malleolus fracture with minimally invasive anterior tibial hollow screw technique can obtain satisfactory clinical effect.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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