摘要
目的:探讨老年踝关节骨折患者的内固定方式的选择情况及不同内固定方式的疗效,进而指导临床医师根据患者的具体情况选择合适的内固定方式。方法:本研究为回顾性研究,选取我院2016年1月~2018年12月期间收治的老年踝关节骨折患者40例作为研究对象,统计患者一般情况,内容包括骨折块情况、骨折类型、骨质疏松情况、软组织情况与体质。术后随访12个月,评价所有患者末次随访时的踝关节跖屈度、踝关节背伸度、美国足踝外科协会(AOFAS)踝-后足功能评分,记录所有患者的骨折愈合时间。结果:40例研究对象中,使用克氏针张力带11例,Herbert螺钉10例,解剖锁定钢板7例,解剖复合钢板6例,1/3管型钢板6例。骨折块较小、外踝撕脱性骨折的患者主要应用克氏针张力带;伴有骨质疏松的患者主要应用解剖锁定钢板;软组织条件不佳或受损的患者主要应用Herbert螺钉或1/3管型钢板;超重或肥胖患者主要应用解剖复合钢板;瘦弱患者主要应用1/3管型钢板。末次随访时,5种内固定方式患者的踝关节背伸度、踝关节跖屈度、AOFAS踝-后足功能评分比较未见显著性差异(P>0.05)。5种内固定方式的骨折愈合时间对比差异存在统计学意义(P<0.05)。结论:老年踝关节骨折应根据患者具体情况选择合理的内固定方式,不同内固定方式患者的骨折愈合时间虽存在差异,但最终均可获得较为满意的疗效。
Objective:To explore the selection of internal fixation methods and the efficacy of different internal fixation methods in patients with elderly ankle fracture,so as to guide clinicians to select the appropriate internal fixation methods according to the specific conditions of patients.Methods:This study was a retrospective study,40 cases of patients with elderly ankle fracture who were admitted to our hospital from January 2016 to December 2018 were selected as the research objects.The general situation of the patients was counted,including fracture block,fracture type,osteoporosis condition,soft tissue condition and constitution.All patients were followed up for 12 months.Ankle plantar flexion,ankle dorsiflexion and American Association of foot and ankle surgery(AOFAS)ankle hindfoot function score were evaluated at the last follow-up of all patients.Fracture healing time of all patients was recorded.Results:Among the 40 cases,11 cases were treated with Kirschner wire tension band,10 cases with Herbert screw,7 cases with anatomical locking plate,6 cases with anatomical composite plate and 6 cases with 1/3 tubular plate.Kirschner wire tension band was mainly used in patients with small fracture mass and avulsion fracture of lateral malleolus.Anatomic locking plate was mainly used in patients with osteoporosis;Herbert screw or 1/3 tubular plate was mainly used in patients with poor or damaged soft tissue condition.Anatomic composite plate was mainly used in overweight or obese patients.1/3 tubular plate was mainly used in thin and weak patients.At the last follow-up,there were no significant differences in ankle dorsiflexion,ankle metatarsal flexion and AOFAS ankle hindfoot function score among the five internal fixation methods(P>0.05).There was significant difference in fracture healing time between the five internal fixation methods(P<0.05).Conclusion:The elderly ankle fracture should be selected according to the specific situation of patients with reasonable internal fixation method.Although there are differences in fracture healing time of patients with different internal fixation methods,they can obtain satisfactory results in the end.
作者
刘晓晖
王星亮
李宏
胡一平
唐可
蔡福金
LIU Xiao-hui;WANG Xing-liang;LI Hong;HU Yi-ping;TANG Ke;CAI Fu-jin(Department of Orthopaedics,904 Hospital of Joint Service Support Force of Chinese People's Liberation Army,Wuxi,Jiangsu,214044,China)
出处
《现代生物医学进展》
CAS
2020年第24期4764-4767,共4页
Progress in Modern Biomedicine
基金
江苏省卫生计生委面上项目(H2017087)
无锡市卫生计生委科研项目(Q201772)。
