中国修复重建外科杂志

中国修复重建外科杂志

切开复位内固定治疗开放与闭合踝关节 Logsplitter 骨折疗效比较

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目的探讨切开复位内固定治疗高能量踝关节 Logsplitter 骨折的临床疗效,并比较开放与闭合 Logsplitter 骨折患者预后差异。方法回顾分析 2011 年 4 月—2016 年 5 月采用切开复位内固定治疗的 36 例 Logsplitter 骨折患者临床资料。其中 15 例为开放骨折脱位(开放组),21 例为闭合骨折脱位(闭合组)。两组患者性别、年龄、合并伤、受伤至入院时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后随访观察患者切口愈合、踝关节活动度恢复、并发症发生及骨折愈合情况等。采用美国矫形足踝协会(AOFAS)评分对患者术后踝关节功能进行评价。结果两组患者均获随访,随访时间 12~29 个月,平均 19 个月;开放组和闭合组随访时间比较差异无统计学意义(t=1.169,P=0.251)。开放组出现术后感染 3 例,骨折不愈合 3 例,创伤后骨关节炎 5 例;闭合组分别有 1 例出现上述并发症;两组除创伤后骨关节炎发生率比较差异有统计学意义(P=0.02)外,其余并发症发生率比较差异均无统计学意义(P=0.41)。末次随访时两组 AOFAS 评分比较差异无统计学意义(t=1.981,P=0.056);开放组获良 10 例、一般 5 例,闭合组获良 13 例、一般 8 例,两组比较差异亦无统计学意义(P=0.796)。两组骨折愈合患者的愈合时间以及踝关节跖屈、背伸、内翻、外翻活动度比较差异均无统计学意义(P>0.05)。结论对开放或闭合 Logsplitter 骨折实施切开复位内固定术均可获得较满意疗效,有效减少并发症发生率,提高患者的踝关节功能。

ObjectiveTo investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture.MethodsThe clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time (P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsBoth groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group (t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; each mentioned complications had 1 case in the closed group; there was no significant difference in complications incidence between the two groups (P=0.41) except post-traumatic osteoarthritis incidence (P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups (t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference (P=0.796). There was no significant difference in the union duration and ankle flexion, dorsal extension, varus, and valgus motion between the two groups (P>0.05).ConclusionOpen reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.

关键词: Logsplitter 骨折; 踝关节骨折; 切开复位内固定; 下胫腓联合

Key words: Logsplitter fracture; ankle fracture; open reduction and internal fixation; distal tibiofibular syndesmosis

引用本文: 任毅, 吴仕舟, 邓伟, 宋润来, 董洪先, 李亚星, 陈宇, 刘运杰, 黄富国, 张晖. 切开复位内固定治疗开放与闭合踝关节 Logsplitter 骨折疗效比较. 中国修复重建外科杂志, 2018, 32(10): 1302-1307. doi: 10.7507/1002-1892.201712073 复制

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