摘要
目的比较无头双加压螺钉与空心螺钉内固定对踝关节骨折患者的治疗效果。方法回顾性分析2012年7月—2018年6月淮北矿工总医院骨科收治踝关节骨折患者100例,男性58例,女性42例;年龄26~71岁,平均48.2岁;道路交通伤33例,摔伤47例,扭伤20例。根据内固定物不同分为无头螺钉组和空心螺钉组,各50例。无头螺钉组行无头双加压螺钉内固定治疗,男性28例,女性22例;年龄27~71岁,平均48.3岁。空心螺钉组行空心螺钉内固定治疗,男性30例,女性20例;年龄26~68岁,平均48.1岁。记录并比较两组患者手术时间、术中出血量和骨折愈合时间。两组患者术后6个月的踝关节功能恢复情况采用美国足踝骨科协会(AOFAS)推荐的踝关节-后足评分标准评价。比较两组患者术前及术后6个月的踝关节活动度以及生活质量。随访1年,观察两组患者术后并发症发生情况。结果无头螺钉组与空心螺钉组的骨折愈合时间[(10.7±1.6)周vs.(12.6±1.8)周]比较,差异有统计学意义(P<0.05)。无头螺钉组术后6个月的踝关节功能恢复情况优于空心螺钉组(P<0.05)。无头螺钉组与空心螺钉组术后6个月的踝关节屈活动度[(28.1±5.2)°vs.(24.8±4.7)°]、伸活动度[(8.8±1.5)°vs.(7.6±1.6)°]、旋前活动度[(19.0±2.6)°vs.(17.2±2.4)°]和旋后活动度[(16.6±2.8)°vs.(14.1±2.5)°]比较,差异有统计学意义(P<0.05)。无头螺钉组与空心螺钉组术后6个月的躯体功能[(72.5±8.8)分vs.(65.1±8.1)分]、心理功能[(73.6±9.1)分vs.(68.3±8.7)分]、社会功能[(68.5±7.2)分vs.(63.1±6.8)分]及物质生活状态[(73.1±9.2)分vs.(67.2±8.7)分]四个维度的生活质量评分比较,差异有统计学意义(P<0.05)。无头螺钉组术后并发症发生率4%,显著低于空心螺钉组的18%(P<0.05)。结论与空心螺钉内固定比较,无头双加压螺钉内固定治疗踝关节骨折有利于骨折术后愈合,对患者踝关节功能、踝关节活动度以及生活质量的改善效果更明显,同时能减少术后并发症的发生。
Objective To compare the effects of headless double compression screw and hollow screw internal fixation on ankle fracture.Methods Totally 100 patients with ankle fracture in Department of Orthopedics,Huaibei Miners General Hospital were selected for retrospective study from Jul.2012 to Jun.2018.There were 58 males and 42 females with an average age of 48.2 years,ranging from 26 to 71 years.There were 33 road traffic injuries,47 falls and 20 sprains.The patients were divided into headless screw group(treated with headless double compression screw internal fixation,n=50)and hollow screw group(treated with hollow screw internal fixation,n=50)according to the difference of internal fixation.The operation time,intraoperative bleeding volume and fracture healing time were recorded and compared between the two groups.The recovery of ankle function in the two groups at 6 months after operation was evaluated by the ankle-hindfoot score standard recommended by the American Orthopaedic Foot and Ankle Society(AOFAS).The ankle motion and quality of life before and 6 months after operation were compared between the two groups.After follow-up for one year,the occurrence of postoperative complications in the two groups was observed.Results The fracture healing time of the headless screw group[(10.7±1.6)weeks]was shorter than that of the hollow screw group[(12.6±1.8)weeks],and the difference was statistically significant(P<0.05).The recovery of ankle function in headless screw group was better than that in the hollow screw group at 6 months after operation(P<0.05).The range of ankle flexion,extension,pronation and supination in the headless screw group[(28.1±5.2)°,(8.8±1.5)°,(19.0±2.6)°,(16.6±2.8)°]were significantly higher than those in the hollow screw group[(24.8±4.7)°,(7.6±1.6)°,(17.2±2.4)°,(14.1±2.5)°],and the differences were statistically significant(P<0.05).The scores of physical,psychological,social function and material life state in the headless screw group[(72.5±8.8)scores,(73.6±9.1)scores,(68.5±7.2)scores,(73.1±9.2)scores]were significantly higher than those in the hollow screw group[(65.1±8.1)scores,(68.3±8.7)scores,(63.1±6.8)scores,(67.2±8.7)scores],and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the headless screw group was 4%,which was significantly lower than 18%in the hollow screw group(P<0.05).Conclusion Compared with hollow screw internal fixation,the treatment of ankle fracture with headless double compression screw internal fixation is conducive to fracture healing after operation.The improvement of patients ankle function and ankle activity and quality of life are more obvious.It can also reduce the occurrence of postoperative complications.
作者
段霄
孟庆丰
汪军玉
乔峰
DUAN Xiao;MENG Qing-feng;WANG Jun-yu;QIAO Feng(Department of Orthopaedics,Huaibei General Miner Hospital,Huaibei,Anhui 235000,China)
出处
《创伤外科杂志》
2020年第9期701-704,708,共5页
Journal of Traumatic Surgery
基金
安徽省卫生计生委科研项目(2017ZY1041)。
关键词
踝关节骨折
无头双加压螺钉
空心螺钉
疗效
ankle fracture
headless double compression screw
hollow screw
curative effect
