青少年创伤性踝内翻截骨矫正两种固定比较△（开放获取）

Internal fixation versus external counterpart in supramalleolar osteotomy for correction of traumatic ankle varus deformity in adolescents

摘要:

[目的]比较踝上截骨（supramalleolar osteotomy, SMOT）钢板内固定与 SMOT 联合 Ilizarov 架牵伸治疗青少年创伤性踝关节内翻畸形（traumatic ankle joint varus deformity, TAVD）临床疗效。[方法]回顾性分析 2015 年 2 月—2022 年 2 月在本院治疗的 30 例青少年 TAVD 患者的临床资料。根据医患沟通结果，16 例采用 SMOT 解剖钢板内固定治疗（内固定组），14 例采用 SMOT 联合 Ilizarov 外固定治疗 （外固定组）。比较两组围手术期、随访与影像资料。[结果] 内固定组在手术时间 [(90.0± 11.6) min vs (102.1±9.1) min, P=0.004]、住院时间 [(13.3±4.4) d vs (18.5±5.3) d, P=0.007] 显著优于外固定组，但前者在术中失血量 [(156.9±46.7) ml vs (90.7±14.4) ml, P＜0.001]、切口总长度 [(14.5±2.3) cm vs (4.6±0.8) cm , P＜0.001] 、下地行走时间 [(71.7±16.7) d vs (5.6±2.3) d, P＜0.001] 显著不及后者。随访时间平均 （20.6±3.5） 个月，术后随时间推移两组 VAS、AOFAS 评分显著改善 （P＜ 0.05）。术后 6 个月，内固定组 VAS 评分显著优于外固定组 [(1.3±1.3) vs (2.6±1.6) , P=0.023]。影像方面，与术前相比，术后两组 TT、TAS 角及 Takakura 分期均显著改善（P＜0.05）。术后 3 个月，内固定组 TAS 角 [(89.8±1.4)° vs (87.6±3.4)°, P=0.036] 及 Takaku- ra 分期 [0/I/II/IIIa/IIIb/IV , (2/11/3/0/0/0) vs (0/7/6/1/0/0) , P=0.038] 显著优于外固定组（P＜0.05）。[结论]两种手术固定方式均能有效治疗青少年 TAVD。与内固定相比，外固定组具有手术创伤小、出血少、早期负重活动、避免植骨等优势，但存在手术时间长、住院时间长、术中透视多，患者痛苦大等缺点。

Abstract:

[Objective] To compare clinical efficacy of supramalleolar osteotomy (SMOT) with plate internal fixation (IF) versus external fixation (EF) by distracting Ilizarov frame for traumatic ankle varus deformity (TAVD) in adolescents. [Methods] A retrospective analysis was performed on 30 adolescent patients with TAVD treated in our hospital from February 2015 to February 2022. According to doctor-patient communication, 16 patients had SMOT with IF of anatomical plate, while other 14 patients were treated with SMOT with EF of distracting Ilizarov frame. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The IF group proved significantly superior to the EF group in terms of operation time [(90.0±11.6) min vs (102.1±9.1) min, P=0.004] and hospital stay [(13.3±4.4) days vs (18.5±5.3) days, P=0.007], whereas significantly inferior to the EF group in terms of intraoperative blood loss [(156.9±46.7) ml vs (90.7± 14.4) ml, P＜0.001], total incision length [(14.5±2.3) cm vs (4.6±0.8) cm, P＜0.001], and postoperative ambulation time [(71.7±16.7) days vs (5.6±2.3) days, P＜0.001]. The mean follow-up period lasted for (20.6±3.5) months on an average, and the VAS and AOFAS scores in both groups were significantly improved over time (P＜0.05). Morever, the IF proved significantly better than the EF group regarding VAS score 6 months postoperatively [(1.3±1.3) vs (2.6±1.6), P=0.023]. Regarding image, talus title (TT), tibial anterior surface angle (TAS), and Takakura scale were significantly improved in both groups after surgery compared with those preoperatively (P＜0.05). The IF group was significantly superior to the EF group in terms of TAS [(89.8±1.4)° vs (87.6±3.4)°, P=0.036] and Takakura grade [0/I/II/IIIa/IIIb/IV, (2/11/3/0/0/0) vs (0/7/ 6/1/0/0), P=0.038] 3 months after surgery. [Conclusion] Both fixation methods in SMOT are effective in the treatment of juvenile TAVD.Compared with internal fixation, the external fixation has advantages of less surgical trauma, less bleeding, early weight-bearing activities, avoiding bone grafting, etc., whereas it has disadvantages such as longer operation time, longer hospital stay, more intraoperative fluoroscopy, and greater pain for patients.