摘要
目的探讨踝关节镜辅助3孔钢板双螺钉固定下胫腓联合治疗Maisonneuve骨折的疗效。方法回顾性分析2015年1月q016年12月于上海交通大学附属第六人民医院骨科收治的22例Maisonneuve骨折患者的临床资料，其中11例行踝关节镜及透视监视下复位外踝及下胫腓联合，有限切开置入3孔钢板并经钢板行双螺钉固定下胫腓联合（简称微创组），另11例行传统的切开复位下胫腓双螺钉固定（简称传统组）。术后门诊随访12—24个月，平均18个月，定期复查x线片，并于术后6个月及12个月根据美国骨科足踝外科协会（AOFAS）踝一后足评分和疼痛视觉模拟评分（VAS）评价治疗效果，并采用独立样本t检验对同组患者术后第6、12个月及两组患者术后同期治疗结果进行统计学分析。结果本研究除微创组1例患者失访外其余患者均获得术后随访，影像学随访明确微创组术后骨折平均12周骨性愈合，传统组术后平均12．5周骨性愈合，下胫腓螺钉均于术后12周取出，取出后两组均未见下胫腓关节再分离发生。微创组术后AOFAS踝一后足评分，术后6个月为（85．9±4．1）分，术后12个月为（90．8±3．7）分，其差异有统计学意义（P〈0．05）；VAS术后6个月为（2．4±1．2）分，术后12个月为（1．1±0．7）分，其差异有统计学意义（P〈0．05）。传统组术后AOFAS踝一后足评分，术后6个月为（81．1±4．7）分，术后12个月为（89．1±3．4）分，其差异有统计学意义（P〈0．05）；而VAS术后6个月为（3．2±1．3）分，术后12个月为（1．0±1．0）分，其差异有统计学意义（P〈0．05）。两组疗效同期比较发现仅术后6个月时的AOFAS踝-后足评分优于传统组（P〈0．05），其余指标均无明显差异。两组均未出现内固定失效、骨不连、畸形愈合及创伤性关节炎等并发症。结论采用关节镜辅助下复位结合钉板系统固定治疗Mmsonneuve骨折创伤小，复位及固定效果可靠，是安全有效的手术技术。
Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopic- assistant plate-screw fixation ofsyndesmosis. Methods From January 2015 to December 2016, totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People＇s Hospital. Eleven patients in minimal invasive surgery （MIS）group were treated by the arthroseopic-assistant plate-screw fixation ofthe syndesmotic injury. Another 11 patients in the control group were performed a classic syndesmosis screw fixation. Plain radiographic examination was carried out during the follow-up. Functional evaluation was measured according to the American Orthopedic Foot Ankle Society （AOFAS） ankle hindfoot score and the Visual analogue scale（VAS）. A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month. Results The patients were followed for an average .18 months （range from 12 to 24 months） except one of MIS group. The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group. The implants of syndesmosis were removed at 12th week post-operatively.No cases of re- diastasis occurred during the follow- up. There was significant difference with in the groups. In the MIS group, the AOFAS ankle hindfoot score was （85.9 ± 4. 1 ） points at 6th month post-operatively, and increased to （90.8 ± 3.7） at 12th month （P 〈 0.05 ）. VAS score was （2.4 ± 1.2） at 6th month and （ 1.1 ± 0.7 ） at 12th month after the operation（P 〈0. 05）. In the control group, the AOFAS ankle hindfoot score was （81.1 ± 4.7） points at 6th month after operation, and increased to （89.1 ± 3.4） at 12th month after operation （P 〈 0.05）. VAS score was （3.2 ±1.3） at the 6th month and （1.0 ± 1.0） at the 12th month after operation（P 〈0.05）. However, for the outcome comparison between the two groups, only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group （ P 〈 0. 05 ）, other results, had no significant difference. Nocomplications of implant failure, nonunion, malunion or post-traumatic arthritis were occurred during the follow- up. Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation, which is a safe and effective surgical method.
作者
阚玉华
徐宏威
廖燚
施忠民
梅国华
薛剑锋
顾文奇
邹剑
张雄良
王晓康
Kan Yuhua;Xu Hongwei;Liao Yi;Shi Zhongmin;Mei G uohua;Xue Jianfeng;Gu Wenqi;Zou Jian;Zhang Xiongliang;Wang Xiaokang(Department of Orthopaedics, The Center Hospital of Kelamayi, Kelamayi 834000, Chin)
出处
《国际外科学杂志》
2018年第7期447-451,共5页
International Journal of Surgery
关键词
踝关节
骨折
骨折固定术
内
关节镜
Ankle joint
Fracture
Fracture fixation
internal
Arthroscopes
作者简介
通信作者：施忠民，Email：18930177323@163．com
