發(fā)布時間：2018-10-17 07:07

【摘要】：目 的 比較經(jīng)內踝截骨入路采用無頭加壓螺釘和空心加壓螺釘內固定治療距骨頸骨折(Hawkins III、IV型)效果。方 法 自2013年3月至2015年3月在我院采用無頭加壓螺釘手術治療的距骨頸骨折20例,其中男性12例,女性8例(實驗組);采用空心加壓螺釘治療的距骨頸骨折患者21例,其中男性13例,女性8例(對照組)。以上患者均經(jīng)內踝截骨入路行內固定治療。記錄患者的手術時間、出血量、住院天數(shù)、傷口愈合、骨折愈合情況、患肢功能(采用美國足踝外科協(xié)會踝與后足評分系統(tǒng)評價)以及距骨壞死等遠期并發(fā)癥的發(fā)生率,從而對采用這兩種手術方法的療效進行對比研究。結 果 全部病例均獲得隨訪,隨訪時間1-2年,平均1.8年。實驗組患者平均年齡為33.25±8.28歲(20-45歲)。實驗組20例距骨頸骨折患者中,其中男性12例,女性8例,按照Hawkins分型,III型13例,IV型7例�；颊咂骄中g時間為61.55±10.64分鐘(45-87分鐘),平均出血量為114.55±38.13ml(45-200ml),平均住院天數(shù)為10.60±2.30天(7-15天)。所有患者手術切口均獲得一期愈合,所有骨折均獲得愈合,但2例術后發(fā)生距骨缺血性壞死,壞死率為10%。按照美國足踝外科協(xié)會踝與后足評分系統(tǒng)(American Orthopaedic Foot and Ankle Society,AOFAS)評價,優(yōu)10例,良8例,可2例,差0例�？傮w優(yōu)良率為90%。對照組患者平均年齡為31.95±7.78歲(21-47歲)。21例距骨頸骨折患者中,其中男性13例,女性8例,按照Hawkins分型,III型12例,IV型9例。患者平均手術時間為61.90±6.02分鐘(44-80分鐘),平均出血量為112.19±20.74ml(50-180ml),平均住院天數(shù)為11.57±1.72天(8-16天)。所有患者手術切口均獲得一期愈合,所有骨折均獲得愈合,但8例術后發(fā)生距骨缺血性壞死,壞死率為38%。按照美國足踝外科協(xié)會踝與后足評分系統(tǒng)(American Orthopaedic Foot and Ankle Society,AOFAS)評價,優(yōu)7例,良6例,可8例,差0例。總體優(yōu)良率為62%。實驗組和對照組患者在年齡和骨折類型方面沒有統(tǒng)計學差異(P0.05),具有可比性。兩組患者在手術時間、出血量和住院天數(shù)上均沒有統(tǒng)計學差異(P0.05)。實驗組患者的距骨壞死率(10%)低于對照組(38%),術后踝關節(jié)功能優(yōu)良率(90%)大于對照組(62%)有統(tǒng)計學差異(P0.05)。結 論 經(jīng)內踝截骨入路采用無頭加壓螺釘比空心加壓螺釘內固定治療距骨頸骨折的療效更加確切,手術切口并發(fā)癥發(fā)生率低,骨折愈合率高,距骨缺血壞死發(fā)生率低。
[Abstract]:Objective to compare the effect of head less compression screw and hollow compression screw in the treatment of talus neck fracture (Hawkins III,IV type) through medial malleolus osteotomy. From March 2013 to March 2015, 20 cases of talus neck fractures were treated with headless compression screws in our hospital, including 12 males and 8 females (experimental group), 21 patients with talus neck fractures treated with hollow compression screws. There were 13 males and 8 females (control group). All patients were treated with internal fixation via medial malleolus osteotomy. Time of operation, amount of blood loss, length of stay in hospital, wound healing, fracture healing, limb function (evaluated by the ankle and hind foot scoring system of the American Association of foot and ankle Surgeons) and the incidence of long term complications such as osteonecrosis of the talus were recorded. The results of the two methods were compared. All cases were followed up for 1-2 years (mean 1.8 years). The mean age of the patients in the experimental group was 33.25 鹵8.28 (20-45 years). In the experimental group, 12 cases were male and 8 cases female. According to Hawkins classification, 13 cases of III type and 7 cases of IV type. The average operation time was 61.55 鹵10.64 minutes (45-87 minutes), the average bleeding volume was 114.55 鹵38.13ml (45-200ml), the average hospitalization time was 10.60 鹵2.30 days (7-15 days). All the patients had primary healing of incision and all fractures were healed, but 2 cases had avascular necrosis of talus after operation, the necrosis rate was 10%. According to the ankle and hind foot scoring system (American Orthopaedic Foot and Ankle Society,AOFAS) of the American Association of ankle Surgeons, 10 cases were excellent, 8 cases were good, 2 cases were fair and 0 cases were poor. The overall excellent and good rate is 90%. The average age of the control group was 31.95 鹵7.78 years (21-47 years). Among 21 cases of talus neck fracture, 13 cases were male and 8 cases were female. According to Hawkins classification, 12 cases of III type and 9 cases of IV type. The average operation time was 61.90 鹵6.02 minutes (44-80 minutes), the average bleeding volume was 112.19 鹵20.74ml (50-180ml), the average hospitalization time was 11.57 鹵1.72 days (8-16 days). All the patients had primary healing of incision and all fractures were healed, but 8 cases had avascular necrosis of talus after operation, the necrosis rate was 38%. According to the ankle and hind foot scoring system (American Orthopaedic Foot and Ankle Society,AOFAS) of the American Association of ankle Surgeons, 7 cases were excellent, 6 cases were good, 8 cases were fair and 0 cases were poor. The overall excellent and good rate is 62. There was no significant difference in age and fracture type between the experimental group and the control group (P0.05), which was comparable. There was no significant difference in operation time, bleeding volume and hospital stay between the two groups (P0.05). The rate of osteonecrosis of talus in the experimental group (10%) was lower than that in the control group (38%). The excellent and good rate of ankle function in the experimental group (90%) was higher than that in the control group (62%) (P0.05). Conclusion the treatment of talus neck fracture with headless compression screw through medial malleolus osteotomy is more accurate than that with hollow compression screw. The complication rate of operative incision is lower, the rate of fracture healing is high, and the rate of avascular necrosis of talus is low.
【學位授予單位】：河北大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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