2种内固定方法治疗98例踝关节骨折的疗效比较

目的比较闭合复位经皮空心螺钉内固定与传统切开复位内固定治疗踝关节骨折的疗效。方法 2004年3月～2009年8月收治的98例非粉碎型内外踝双骨折根据内固定方法不同分为闭合复位经皮空心螺钉内固定(闭合复位组)和传统切开复位内固定(切开复位组),比较2组患者的手术时间、术中出血量、骨折愈合时间、骨折愈合后外踝有无疼痛及术后1年AOFAS足踝评分。结果闭合复位组术中出血量、术后切口感染发生率及骨折愈合后外踝出现疼痛发生率明显优于切开复位组(P<0.05)。闭合复位组51例术后随访16～81个月,平均29.7月,骨折全部愈合;切开复位组42例随访17～80个月,平均28.3月,4例出现切口红肿、皮缘坏死,经换药后切口愈合,无深部感染发生,1例出现骨折不愈合。结论与传统切开复位内固定比较,闭合复位经皮空心螺钉内固定治疗踝关节骨折具有出血少、术后切口并发症发生率低、骨折愈合后外踝疼痛发生率低的优点,并能获得与切开复位内固定等同的踝关节功能。

Comparison of Closed Reduction and Percutaneous Hollow Screws Fixation with Open Reduction and Internal Fixation for the Treatment of Ankle Fractures:Report of 28 Cases

Objective To compare the curative effects of closed reduction plus percutaneous hollow screw internal fixation and traditional open reduction plus internal fixation for ankle fractures.Methods We retrospectively analyzed 98 patients who were admitted to our department for non-comminuted ankle fracture from March 2004 to August 2009.According to different internal fixation methods,the patients were divided into closed reduction group with percutaneous hollow screw internal fixation and open reduction group with internal fixation.The operation time,intraoperative blood loss,fracture healing time,lateral malleolar pain and the score of AOFAS at the end of follow-up were compared.Results Closed reduction group showed significantly less intraoperative blood loss,and lower rates of incisional infection and post-recovery malleolar pain than open reduction group(all P<0.05).The closed reduction group achieved a mean of 29.7-month follow-up(16-81 months) in 51 cases,in all of which the fracture was healed.In the open reduction group,42 cases received follow-up for 17 to 80 months with a mean of 28.3 months,4 of the cases developed incisional inflammation,or necrosis without deep infection;they were then healed by conservative treatment;one of the 42 patient had nonunion.Conclusion Compared with traditional open reduction with internal fixation,closed reduction with percutaneous hollow screw internal fixation for ankle fractures results in less blood and incisional infection,less outer ankle pain after bone union,but similar ankle joint function.