前后螺钉和后前螺钉治疗后踝骨折患者效果比较

目的比较间接复位、经皮前后螺钉和直接复位、后前螺钉两种方式固定后踝骨折的疗效。方法回顾性分析2013年1月至2017年12月广东医科大学附属医院骨科收治的后踝骨折空心螺钉固定患者58例,根据治疗方法不同分为前后螺钉组(26例)和后前螺钉组(32例),比较两组患者术后螺钉位置不良的发生率及其他并发症发生情况和末次随访时的踝关节功能情况。结果前后螺钉组螺钉位置不良发生率为23.08%(6/26),明显高于后前螺钉组的3.85%(1/32),两组比较差异有统计学意义(χ^2=5.381,P=0.020);而其他并发症如感染率、创伤性关节炎、骨不连发生率比较差异均无统计学意义(P均>0.05)。末次随访,前后螺钉组的Olerud-Molander踝关节评分(Olerud-Molander ankle score,OMAS)和美国骨科足踝评分(American orthopaedic foot and ankle society,AOFAS)均低于后前螺钉组,两组比较差异有统计学意义[OMAS:前后螺钉组为(80.70±8.16)分、后前螺钉组为(75.23±9.33)分,t=2.240,P=0.029;AOFAS:前后螺钉组为(80.57±7.25)分、后前螺钉组为(75.38±10.19)分,t=2.110,P=0.039]。结论间接复位、经皮前后螺钉治疗后踝骨折具有较高的螺钉位置不良发生率,对踝关节功能造成影响;直接复位、后前螺钉固定的方法能显著减少螺钉位置不良发生率,获得更好的功能结果。

Comparison of lag screw fixation on posterior malleolar fractures in different directions and screw-related complication

Objective To compare the effects of indirect reduction,percutaneous anterior posterior screw and direct reduction,posterior anterior screw in the treatment of posterior malleolus fracture.Methods A retrospective analysis was made on 58 patients with posterior malleolus fracture treated by cannulated screw fixation from January 2013 to December 2017 in the Department of Orthopedics,Affiliated Hospital of Guangdong Medical University.They were divided into anterior and posterior screw group(26 cases)and posterior and anterior screw group(32 cases)according to different treatment methods.The incidence of poor screw position and other complications were compared between the two groups.Health status and ankle function at the last follow-up were compared between the two groups.Results The incidence of screw malposition in the anterior and posterior screw fixation group was 23.08%(6/26),which was significantly higher than that in the posterior screw fixation group was 3.85%(1/32).The difference between the two groups has statistically significant(χ^2=5.381,P=0.020);there was no significant difference in other complications such as infection,traumatic arthritis,bone nonunion(all P>0.05).At the last follow-up,the OMA scores of AP group were(80.70±8.16)and PA group were(75.23±9.33),There were significant differences between the two scores(t=2.240,P=0.029),the AOFAS scores of AP group were(80.57±7.25)and PA group were(75.38±10.19),There were significant differences between the two scores(t=2.110,P=0.039).Conclusion The Indirect reduction and percutaneous anterior and posterior screw treatment have a high incidence of malposition of the screw,which has an impact on ankle function.Direct reduction and posterior and anterior screw fixation can significantly reduce the incidence of malposition of the screw and obtain better functional results.