| 改良前外侧入路联合改良后内侧入路治疗三踝骨折疗效的病例对照研究 |
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投稿时间：2019-02-16
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| 作者 | Author | 单位 | Address | E-Mail |
| 王志焘 |
WANG Zhi-tao |
苏州大学附属第二医院骨科, 江苏 苏州 215004 |
Department of Orthopaedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China |
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| 詹俊锋 |
ZHAN Jun-feng |
安徽医科大学附属第二医院足踝外科, 安徽 合肥 230000 |
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| 朱楠 |
ZHU Nan |
安徽医科大学附属第二医院足踝外科, 安徽 合肥 230000 |
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| 徐又佳 |
XU You-jia |
苏州大学附属第二医院骨科, 江苏 苏州 215004 |
Department of Orthopaedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China |
xuyoujia@suda.edu.cn |
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| 期刊信息：《中国骨伤》2019年，第32卷，第11期，第1014-1020页 |
| DOI：10.3969/j.issn.1003-0034.2019.11.008 |
| 基金项目:国家自然科学基金项目（编号：81874018） |
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中文摘要:
目的：比较改良前外侧入路联合改良后内侧入路和传统后外侧入路辅助内侧切口治疗三踝骨折的临床效果。
方法：自2015年1月至2017年8月选取108例三踝骨折患者分为改良入路组（试验组）和传统入路组（对照组）。试验组53例，男31例，女22例；年龄18~67（40.2±16.4）岁；左侧19例，右侧34例；旋后外旋型39例，旋前外旋型14例；术前等待时间6~14（9.6±3.1）d；手术采用改良前外侧入路联合改良后内侧入路。对照组55例，男34例，女21例；年龄19~69（42.1±15.3）岁；左侧18例，右侧37例；旋后外旋型42例，旋前外旋型13例；术前等待时间7~16（10.3±3.4）d；手术采用传统后外侧入路辅助内侧切口。对比两组手术时间、术中出血量、术后引流量、切口并发症例数及复位质量评定、骨折愈合时间、神经损伤例数、屈肌挛缩例数和切口并发症总例数；术后1年采用美国足踝外科协会（American Orthopedic Foot and Ankle Society，AOFAS）踝与后足功能评分进行临床疗效评价。
结果：108例患者均获得随访，时间12~24（16.4±7.5）个月。试验组手术时间（95.3±22.6）min，术中出血量（114.7±68.7）ml，术后引流量（127.5±87.8）ml，切口并发症1例，均少于对照组（112.5±53.8）min、（155.2±79.6）ml、（178.4±73.8）ml和3例。试验组复位质量优36例，良14例，差3例；对照组优30例，良15例，差10例；试验组优于对照组。试验组骨折愈合时间（5.5±1.6）个月，2例出现切口并发症；对照组骨折愈合时间（6.7±2.1）个月，12例出现切口并发症；试验组少于对照组。术后1年试验组AOFAS评分（92.9±18.4）分，高于对照组（80.3±38.3）分；根据AOFAS评分标准，试验组优32例，良17例，可3例，差1例；对照组优25例，良18例，可8例，差4例；两组比较差异有统计学意义。
结论：改良前外侧入路联合改良后内侧入路和传统后外侧入路辅助内侧切口治疗三踝骨折均能取得良好的疗效。相比传统后外侧入路辅助内侧切口，改良前外侧联合改良后内侧入路治疗三踝骨折符合局部软组织血供特点，具有手术创伤小、操作安全、显露清楚有效等优点。 |
| 【关键词】踝骨折 骨折固定术 病例对照研究 |
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| Case-control studies on modified anterolateral approach with modified postmedial approach for the treatment of trimalleolar fractures |
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ABSTRACT
Objective: To compare clinical effect of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures.
Methods: From January 2015 to August 2017,108 patients with trimalleolar fractures were enrolled and randomly divided into modified approaches (experimental group) and conventional approaches(control group). There were 53 patients in experimental group including 31 males and 22 females aged from 18 to 67 years old with an average of(40.2±16.4) years old;19 patients on the left side and 34 patients on the right side;39 patients were supination external rotation and 14 patients were pronation-external rotation;preoperative waiting time ranged from 6 to 14 d with an average of(9.6±3.1) d;performed operation through modified anterolateral approach combined with modified posteromedial approach. There were 55 patients in control group,including 34 males and 21 females aged from 19 to 69 years old with an average of (42.1±15.3) years old;18 patients on the left side and 37 patients on the right side;42 patients were supination external rotation and 13 patients were pronation-external rotation;preoperative waiting time ranged from 7 to 16 d with an average of (10.3±3.4) d;performed operation through conventional posterolateral approach combined with medial-aided. Operation time,intraoperative blood loss,postoperative drainage volume,cases of incision complications and excellent-good reduction,fracture healing time,cases of nerve injury and muscular flexor contracture,cases of incision complications between two groups were compared;AOFAS score were used to evaluate clinical efficacy at 1 year after operation.
Results: All patients were followed up from 12 to 24 months with an average of (16.4 ±7.5) months. Operation time,intraoperative blood loss,postoperative drainage volume and incision complication in experimental group were (95.3±22.6) min,(114.7±68.7) ml,(127.5±87.8) ml and 1 case,respectively;while in control group were (112.5±53.8) min,(155.2±79.6) ml,(178.4±73.8) ml and 3 cases respectively;the data in experimental group were better than that of control group. In experimental group,36 cases got excellent results,14 good and 3 poor on the quality of reduction,while 30 patients got excellent results,15 good and 10 poor in control group;the experimental group was better than control group. Fracture healing time in experimental group were(5.5±1.6) months,2 patients occurred incision complications,while(6.7±2.1) months,12 patients in control group;the experiment group were better than control group. Postoperative AOFAS score at 12 months in experimental group was 92.9±18.4,and better than control group 80.3±38.3;32 patients got excellent results,17 good,3 moderate and 1 poor in experimental group;25 patients got excellent results,18 good,8 moderate and 4 poor in control group;there was statistical difference between two groups.
Conclusion: Both of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures could receive good clinical effect. While compared with conventional posterolateral approach combined with medial-aided,modified anterolateral approach combined with modified posteromedial approach is more fit for blood supply of local soft tissue,and has advantages of less trauma,safety operation and clearly exposure. |
| KEY WORDS Ankle fractures Fracture fixation Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王志焘,詹俊锋,朱楠,徐又佳.改良前外侧入路联合改良后内侧入路治疗三踝骨折疗效的病例对照研究[J].中国骨伤,2019,32(11):1014~1020 |
| 英文格式: | WANG Zhi-tao,ZHAN Jun-feng,ZHU Nan,XU You-jia.Case-control studies on modified anterolateral approach with modified postmedial approach for the treatment of trimalleolar fractures[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(11):1014~1020 |
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