手术与手法复位治疗踝关节骨折的临床疗效分析

目的:探讨手术与手法复位治疗不同踝关节骨折的临床效果。方法:回顾分析自2006年3月至2010年4月收治的踝关节骨折患者,从中选取资料完整的301例。手法复位石膏固定组134例,男86例,女48例;平均年龄(38.2±15.7)岁;Weber-Denis A型55例,B型60例,C型19例。手术治疗组167例,男115例,女52例;平均年龄(39.6±11.9)岁;Weber-Denis A型59例,B型52例,C型56例。根据Mazur制定的踝关节症状与功能评分标准对患者进行术后评分,比较2种治疗方法的疗效。结果:Weber-Denis A型114例,手法组55例,功能优、良、可、差者分别为18、20、11和6例;手术组59例,功能优、良、可、差者分别为26、25、6和2例,2组比较差异无统计学意义(P=0.150)。Weber-Denis B型112例,手法组60例,功能优、良、可、差者分别为20、26、8和6例;手术组52例,功能优、良、可、差者分别为25、21、5和1例,2组比较差异无统计学意义(P=0.190)。Weber-Denis C型75例,手法组19例,优、良、可、差者分别为2、3、7和7例;手术组56例,优、良、可、差者分别为21、18、11和6例,2组比较差异有统计学意义(P=0.007)。结论:Weber-Denis C型骨折,手术组患者疗效高于手法治疗组,该型骨折患者应积极手术治疗。

Clinical effects of surgical vs manual reduction of ankle fractures

Objective:To investigate the clinical effects of surgical vs manual reduction of ankle fractures. Methods:From March 2006 to April 2010,301 patients with ankle fractures were analyzed retrospectively,of whom 134 patients were treated by manual reduction and plaster fixation,and the other 167 patients underwent surgical treatment. In manual reduction group,there were 86 males and 48 females with a mean age of(38.2±15.7) years,involving Weber-Denis A in 55 cases,Weber-Denis B in 60 cases,and Weber-Denis C in 19 cases. In surgical reduction group,there were 115 males and 52 females with a mean age of (39.6±11.9) years,involving Weber-Denis A in 59 cases,Weber-Denis B in 52 cases and Weber-Denis C in 56 cases. The score of the ankle's symptoms and function was calculated according to Mazur,and the difference was analyzed by Chi-squire test. Results:Of the 114 patients with Weber-Denis A,55 patients were in manual reduction group,with excellent,good,acceptable and poor results in 18,20,11 and 6 patients respectively vs 26,25,6 and 2 in surgical reduction group of 59 patients. In patients with Weber-Denis B,there were 60 patients in manual reduction group,with excellent,good,acceptable and poor results in 20,26,8 and 6 patients vs 25,21,5,and 1 in surgical reduction group of 52 patients. There was no significant difference in clinical effects between the two group of Weber-Denis A and B. The remaining 75 patients belonged to Weber-Denis C,of whom 19 patients were in manual reduction group,with excellent,good,acceptable and poor results in 2,3,7 and 7 patients vs 21,18,11 and 6 in surgical reduction group of 56 patients. There was no significant difference in clinical effects between the two groups of Weber-Denis C(P=0.007). Conclusion:The clinical effect of surgical reduction group was obviously better than that of manual reduction group for Weber-Denis C,and therefore surgical intervention is recommended for this type of fracture.