后踝不同大小骨塊手術(shù)與保守治療臨床療效分析
發(fā)布時(shí)間：2018-11-07 13:30
【摘要】：目的:通過(guò)對(duì)比保守與手術(shù)治療后踝骨折的預(yù)后指標(biāo),探討不同大小骨塊后踝骨折最佳治療策略,以期達(dá)到滿意的臨床預(yù)后標(biāo)準(zhǔn),取得更好遠(yuǎn)期療效。方法:回顧性分析對(duì)比大連醫(yī)科大學(xué)附屬第二醫(yī)院2011年8月至2014年8月期間,累及后踝的單側(cè)閉合性踝關(guān)節(jié)骨折75例。分為手術(shù)與保守治療兩組。其中手術(shù)治療組,男性:14人,女性:22人;左、右踝:14、22例;年齡(均數(shù)±標(biāo)準(zhǔn)差):46.50±16.20歲,根據(jù)后踝骨塊大小分為(I:骨塊累及關(guān)節(jié)面25%,骨塊移位2mm。II:骨塊累及關(guān)節(jié)面25%,骨塊移位2mm)。其中I:10人、II:26人;受傷方式:高處墜落傷11人、交通意外6人、扭傷19人。保守治療組,男性:19人,女性:20人;左、右踝:15、24例;年齡(均數(shù)±標(biāo)準(zhǔn)差):49.50±15.8歲;I:25人、II:14人;受傷方式:高處墜落傷10人、交通意外7人、扭傷22人。AO(B型):38人;AO(C型):37人。比較兩組患者年齡、性別、受傷方式、骨折分型,無(wú)差異(P0.05)。從而選用(AOFAS)美國(guó)踝-后足評(píng)分系統(tǒng)對(duì)比兩組患者踝關(guān)節(jié)功能及治愈率,通過(guò)影像學(xué)資料比較兩組患者骨折愈合時(shí)間并記錄末次隨訪時(shí)踝關(guān)節(jié)X線片的關(guān)節(jié)平整度。結(jié)果:患者平均隨訪16個(gè)月(6-26),失訪3人,其中2例患者外踝切口周圍皮膚發(fā)紅,經(jīng)涂抹外用抗生素、換藥等處置后切口愈合,1例患者外踝側(cè)切口愈合欠佳,經(jīng)按時(shí)換、油紗覆蓋后切口完全愈合,余兩組患者術(shù)后均無(wú)骨折不愈合、延遲愈合、斷釘?shù)惹闆r。當(dāng)后踝骨塊小于25%關(guān)節(jié)面時(shí),手術(shù)治療組(10例)踝-后足評(píng)分:92.70±6.88,優(yōu)、良、可、差(6、3、1、0),優(yōu)良率90%;保守治療組(25例)踝-后足評(píng)分:91.48±7.11,優(yōu)、良、可、差(15、7、3、0),優(yōu)良率88%,經(jīng)統(tǒng)計(jì)學(xué)分析,兩組無(wú)差異(P0.05)。但當(dāng)骨塊大于25%關(guān)節(jié)面時(shí),手術(shù)治療組(26例)踝-后足評(píng)分:89.25±7.15,優(yōu)、良、可、差(14、8、3、1),優(yōu)良率84.6%;保守治療組(14例)AOFAS評(píng)分:76.78±8.29,優(yōu)、良、可、差(4、6、2、2),優(yōu)良率71.4%,經(jīng)計(jì)算數(shù)據(jù)有差異(P0.05)。骨折愈合時(shí)間:手術(shù)組(11.4±1.2W),保守組(12.9±1.6W)統(tǒng)計(jì)學(xué)有差異(P0.05)。共隨訪的75例患者中,2人出現(xiàn)重度關(guān)節(jié)退變7人出現(xiàn)不同程度的輕中度關(guān)節(jié)退變,余患者末次隨訪時(shí)踝關(guān)節(jié)X線平整度正常。結(jié)論:踝關(guān)節(jié)骨折中,當(dāng)后踝骨塊累及關(guān)節(jié)面25%、骨塊移位2mm時(shí),有效的內(nèi)固定明顯優(yōu)于保守治療。當(dāng)距骨后脫位、骨塊移位明顯或伴有下脛腓聯(lián)合分離時(shí),即使骨塊累及關(guān)節(jié)面25%,也應(yīng)手術(shù)固定。對(duì)后踝撕脫骨折或移位不明顯2mm、骨塊較小25%時(shí),可復(fù)位后保守治療。脛前微創(chuàng)空心螺釘技術(shù)對(duì)后踝骨折的治療可取得滿意的臨床效果。
[Abstract]:Objective: to compare the prognostic indexes of ankle fracture after conservative and surgical treatment and to explore the best treatment strategy of ankle fracture with different size of bone mass in order to achieve satisfactory clinical prognostic standard and obtain better long-term curative effect. Methods: 75 cases of unilateral closed ankle fractures involving posterior malleolus in the second affiliated Hospital of Dalian Medical University from August 2011 to August 2014 were retrospectively analyzed and compared. The patients were divided into two groups: operation group and conservative treatment group. In the surgical treatment group, 14 cases were male, 22 cases were female, and 14 cases were left and right ankle. Age (mean 鹵standard deviation): 46.50 鹵16.20 years old. According to the size of posterior malleolar bone, it was divided into two parts (I: bone mass involving articular surface 25 mm. II: bone mass displacement 2 mm. II: bone mass involving articular surface 25, bone mass shifting 2mm). Among them, I: 10, II:26; injuries: 11 people fall, 6 traffic accidents, 19 sprain. Conservative treatment group (male: 19, female: 20; left, right ankle: 15; age (mean 鹵standard deviation): 49.50 鹵15.8; I: 25, II:14; Injury pattern: fall injury 10, traffic accident 7, sprain 22. AO (B): 38; AO (C): 37. There was no difference in age, sex, injury style, fracture classification between the two groups (P0.05). The ankle function and cure rate of the two groups were compared by (AOFAS) American ankle-hind foot scoring system. The fracture healing time of the two groups was compared by imaging data and the joint smoothness of the ankle X-ray film at the last follow-up was recorded. Results: the patients were followed up for an average of 16 months (6-26), 3 of them were not interviewed. The skin around the lateral malleolus incision was redness in 2 patients, the incision healed after applying antibiotics and dressing change, and one patient had poor lateral malleolus incision healing. After changing on time, the incision healed completely after covering with oil gauze, the other two groups had no fracture nonunion, delayed healing, broken nail and so on. When the posterior malleolar mass was less than 25% of the articular surface, the ankle-hind foot score of the surgical treatment group (10 cases) was 92.70 鹵6.88, excellent, good, fair and poor (6). The excellent and good rate was 90. In the conservative treatment group (25 cases), the ankle-hind foot score was 91.48 鹵7.11, excellent, good, fair and poor (157f3 / 0). The excellent and good rate was 880.There was no difference between the two groups (P0.05). But when the bone mass was more than 25%, the ankle-hind foot score of the surgical treatment group (26 cases) was 89.25 鹵7.15, excellent, good, fair and poor (14). The excellent and good rate was 84.6%. In the conservative treatment group (14 cases), the AOFAS score was 76.78 鹵8.29, excellent, good, fair and poor (40.66% 2P 2), and the excellent and good rate was 71.4% (P0.05). Fracture healing time: operation group (11.4 鹵1.2 W), conservative group (12.9 鹵1.6 W) statistical difference (P0.05). Of the 75 cases followed up, 2 had severe degenerative joint and 7 had mild to moderate joint degeneration, and the rest had normal X-ray of ankle joint at the last follow-up. Conclusion: in ankle fracture, the effective internal fixation is superior to conservative treatment when the posterior malleolar mass involves the articular surface 25 and the bone mass shifts 2mm. When the dislocation of posterior talus is obvious or accompanied by the separation of inferior tibiofibular syndesmosis, the bone mass should be fixed surgically even if it involves 25% of the articular surface. When the posterior malleolus avulsion fracture or displacement is not obvious 2 mm and the bone mass is smaller than 25 mm, the posterior malleolus can be reduced and treated conservatively. The treatment of posterior malleolus fracture with minimally invasive anterior tibial hollow screw technique can obtain satisfactory clinical effect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2316515
[Abstract]:Objective: to compare the prognostic indexes of ankle fracture after conservative and surgical treatment and to explore the best treatment strategy of ankle fracture with different size of bone mass in order to achieve satisfactory clinical prognostic standard and obtain better long-term curative effect. Methods: 75 cases of unilateral closed ankle fractures involving posterior malleolus in the second affiliated Hospital of Dalian Medical University from August 2011 to August 2014 were retrospectively analyzed and compared. The patients were divided into two groups: operation group and conservative treatment group. In the surgical treatment group, 14 cases were male, 22 cases were female, and 14 cases were left and right ankle. Age (mean 鹵standard deviation): 46.50 鹵16.20 years old. According to the size of posterior malleolar bone, it was divided into two parts (I: bone mass involving articular surface 25 mm. II: bone mass displacement 2 mm. II: bone mass involving articular surface 25, bone mass shifting 2mm). Among them, I: 10, II:26; injuries: 11 people fall, 6 traffic accidents, 19 sprain. Conservative treatment group (male: 19, female: 20; left, right ankle: 15; age (mean 鹵standard deviation): 49.50 鹵15.8; I: 25, II:14; Injury pattern: fall injury 10, traffic accident 7, sprain 22. AO (B): 38; AO (C): 37. There was no difference in age, sex, injury style, fracture classification between the two groups (P0.05). The ankle function and cure rate of the two groups were compared by (AOFAS) American ankle-hind foot scoring system. The fracture healing time of the two groups was compared by imaging data and the joint smoothness of the ankle X-ray film at the last follow-up was recorded. Results: the patients were followed up for an average of 16 months (6-26), 3 of them were not interviewed. The skin around the lateral malleolus incision was redness in 2 patients, the incision healed after applying antibiotics and dressing change, and one patient had poor lateral malleolus incision healing. After changing on time, the incision healed completely after covering with oil gauze, the other two groups had no fracture nonunion, delayed healing, broken nail and so on. When the posterior malleolar mass was less than 25% of the articular surface, the ankle-hind foot score of the surgical treatment group (10 cases) was 92.70 鹵6.88, excellent, good, fair and poor (6). The excellent and good rate was 90. In the conservative treatment group (25 cases), the ankle-hind foot score was 91.48 鹵7.11, excellent, good, fair and poor (157f3 / 0). The excellent and good rate was 880.There was no difference between the two groups (P0.05). But when the bone mass was more than 25%, the ankle-hind foot score of the surgical treatment group (26 cases) was 89.25 鹵7.15, excellent, good, fair and poor (14). The excellent and good rate was 84.6%. In the conservative treatment group (14 cases), the AOFAS score was 76.78 鹵8.29, excellent, good, fair and poor (40.66% 2P 2), and the excellent and good rate was 71.4% (P0.05). Fracture healing time: operation group (11.4 鹵1.2 W), conservative group (12.9 鹵1.6 W) statistical difference (P0.05). Of the 75 cases followed up, 2 had severe degenerative joint and 7 had mild to moderate joint degeneration, and the rest had normal X-ray of ankle joint at the last follow-up. Conclusion: in ankle fracture, the effective internal fixation is superior to conservative treatment when the posterior malleolar mass involves the articular surface 25 and the bone mass shifts 2mm. When the dislocation of posterior talus is obvious or accompanied by the separation of inferior tibiofibular syndesmosis, the bone mass should be fixed surgically even if it involves 25% of the articular surface. When the posterior malleolus avulsion fracture or displacement is not obvious 2 mm and the bone mass is smaller than 25 mm, the posterior malleolus can be reduced and treated conservatively. The treatment of posterior malleolus fracture with minimally invasive anterior tibial hollow screw technique can obtain satisfactory clinical effect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
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