经皮空心加压螺钉与切开复位内固定修复单纯内踝骨折：关节功能恢复比较

背景：踝关节是人体最重要的关节之一，其中内踝骨折十分多见，对该类骨折的修复方式有多种，常用也是较为传统的为切开复位内固定，随着骨折修复的理念转变，目前闭合复位经皮空心钉固定日趋流行，然而两种方式的疗效对比仍需大量临床资料分析。目的：对比切开复位内固定与经皮空心加压螺钉置入内固定修复内踝骨折的关节功能恢复情况。方法：纳入广东省信宜市人民医院骨科2009年3月至2013年3月收治的单纯内踝骨折患者63例，根据修复方案分为两组，切开复位内固定组29例，经皮空心加压螺钉内固定组34例。分别于入院时、修复后3个月按照Kofoed评分标准进行患者踝关节功能评定。结果与结论：患者随访3-12个月。切开复位内固定组29例中27例切口甲级愈合，2例切口乙级愈合；骨折解剖复位29例，复位不良0例。经皮空心加压螺钉内固定组34例中切口均甲级愈合，解剖复位均固定良好。所有患者均骨性愈合，无感染等并发症。按照Kofoed评分，3个月随访时，切开复位内固定组踝关节评分满意率为97%，经皮空心加压螺钉内固定组满意率为100%。提示切开复位内固定与经皮空心加压螺钉置入内固定修复内踝骨折均有肯定的疗效，但经皮空心加压螺钉置入内固定创伤小，可减少感染率，有利于早期踝关节功能恢复锻炼。

Percutaneous cannulated screw fixation versus open reduction and internal fixation for medial malleolus fracture: recovery of joint function

BACKGROUND:The ankle is one of the most important joints of human body. Medial malleolar fractures are very common, and there are lots of surgical methods to treat it. A traditional approach is open reduction and internal fixation. As views changed, percutaneous cannulated screw internal fixation become increasingly popular, but various clinical studies are still needed to analyze the efficacy of these two methods. OBJECTIVE:To compare the recovery of joint function after medial malleolus fracture repaired by open reduction and internal fixation and percutaneous cannulated screw fixation.  METHODS:A total of 63 cases of medial malleolus fracture, who were treated in the Department of Orthopedics, People’s Hospital of Xinyi City from March 2009 to March 2013, were enrolled. According to repair plan, they were divided into two groups: open reduction and internal fixation group (n=29) and percutaneous cannulated screw fixation group (n=34). Ankle function was assessed in accordance with Kofoed ankle score standard on admission and at 3 months after repair. RESULTS AND CONCLUSION:The patients were followed up for 3 to 12 months. Among 29 cases in the open reduction and internal fixation group, the wound was healed at grade A in 27 cases and at grade B in 2 cases; 29 cases were reset, and no poor reduction was found. In the percutaneous cannulated screw fixation group, 34 cases had healing at grade A, with the presence of good reduction. All patients experienced bone union, and no  infection appeared. In accordance with Kofoed score, at 3 months of follow-up, the satisfaction rate was 97% in the open reduction and internal fixation group, and 100% in the percutaneous cannulated screw fixation group. These data suggest that both open reduction and internal fixation and percutaneous cannulated screw fixation for medial malleolus fracture obtained positive effects, but percutaneous cannulated screw fixation showed small surgical trauma, which could reduce the rate of infection and contributed to early functional recovery of ankle joint.