经后外侧入路切开与闭合复位内固定于后踝骨折中的应用效果比较

目的 观察比较经后外侧入路切开与闭合复位内固定于后踝骨折中的应用效果及安全性。 方法 回顾性分析合并后踝骨折的踝关节骨折患者87例的临床资料，依据治疗手术方式不同分为切开组（n=44）和闭合组（n=43）。切开组采用经后外侧入路切开复位内固定，闭合组采取闭合复位内固定。比较2组手术相关指标、并发症、术后12个月踝关节功能恢复优良率、术前、术后2周、4周骨代谢指标［Ⅰ型胶原羧基端肽β特殊序列（β-carboxy Ⅰ terminal peptide，β-CTX）、Ｉ型前胶原羧基端肽（procollagen type Ⅰ carboxy-terminal peptide，PICP）、骨钙素（bone gla protein，BGP）］、术后6个月、术后12个月踝关节活动度。 结果 闭合组手术时间、骨折愈合时间短于切开组，术中出血量少于切开组（P＜0.05）。2组血清β-CTX水平呈逐渐降低趋势，PＩCP、BGP水平呈逐渐升高趋势，闭合组血清β-CTX、PＩCP、BGP水平变化幅度较大，组间、时点间、组间·时点间交互作用比较，差异有统计学意义（P＜0.05）。闭合组术后并发症发生率低于切开组（P＜0.05）。2组术后6个月、12个月跖屈、背屈、外翻、内翻活动度差异无统计学意义（P＞0.05）。2组术后12个月踝关节功能恢复优良率差异无统计学意义（P＞0.05）。 结论 与经后外侧入路切开复位内固定相比，闭合复位内固定治疗后踝骨折具有手术便捷、创伤小、并发症少、术后骨代谢指标改善及骨折愈合快等优点，且术后踝关节功能恢复良好。

Comparison of the application effect of open and closed reduction and internal fixation in posterior malleolus fractures via posterolateral approach

ObjectiveTo observe and compare the application effect and safety of open and closed reduction and internal fixation in posterior malleolus fractures via posterolateral approach.MethodsThe clinical data of 87 patients with ankle fracture combined with posterior malleolus fracture were retrospectively analyzed, and they were divided into the open group(n=44) and the closed group(n=43) according to different treatment methods. The open group was treated with open reduction and internal fixation via the posterolateral approach, and the closed group was treated with closed reduction and internal fixation. Operation-related indexes, complications, excellent and good rate of ankle joint function recovery at 12 months after operation, bone metabolism indexes before operation, at 2 weeks and 4 weeks after operation［type Ⅰ collagen carboxy-terminal peptide β special sequence(β-CTX), procollagen type Ⅰ carboxy-terminal peptide(PICP), bone gla protein(BGP)］,and ankle range of motion(ROM)at 6 months and 12 months after surgery were compared.ResultsThe duration of operation and fracture healing time of the closed group were shorter than those of the open group, and the intraoperative blood loss was less than that of the open group(P＜0.05).Serum β-CTX levels in the two groups showed a gradually decreasing trend, while PICP and BGP levels gradually increased.The difference of interaction between groups, time points and time points between groups were statistically significant(P＜0.05). The incidence of postoperative complications in the closed group was lower than that in the open group(P＜0.05). There was no significant difference in the ROM of plantar flexion, dorsiflexion, valgus and varus between the two groups at 6 and 12 months after operation(P＞0.05).There was no significant difference in the excellent and good rate of ankle function recovery between two groups at 12 months after operation(P＞0.05).ConclusionCompared with open reduction and internal fixation via the posterolateral approach, closed reduction and internal fixation for the treatment of posterior ankle fractures has the advantages of convenient operation, less trauma, fewer complications, improved postoperative bone metabolism indexes, and faster fracture healing. Ankle joint function has recovered well.