拉力钉与支撑钢板固定HaraguchiⅠ型后踝骨折比较△

Posterior-anterior lag screw versus buttress plate for fixation of Haraguchi type I posterior malleolus fractures

摘要:

[目的] 比较后前拉力螺钉与支撑钢板治疗Haraguchi Ⅰ型后踝骨折的临床效果。[方法] 回顾性分析2020 年6 月—2022 年9 月开放复位内定治疗Haraguchi Ⅰ型后踝骨折80 例患者的临床资料。根据医患沟通结果，38 例采用后前拉力螺钉固定后踝（螺钉组），另外42 例采用支撑钢固定后踝（钢板组），同时间处理合并的外踝和内踝骨折。比较两组围术期、随访及影像学资料。[结果] 螺钉组在手术时间[(69.5±4.6) min vs (90.2±6.4) min, P＜0.001]、切口总长度[(9.0±2.3) cm vs (10.3±2.6) cm, P=0.021]、术中失血量[(104.8±20.5) ml vs (116.0±21.3) ml, P=0.019] 均显著少于钢板组，但螺钉组下地行走时间[(64.8±3.7) d vs(60.0±4.0) d, P=0.019] 显著晚于钢板组，两组完全负重活动时间的差异无统计学意义（P＞0.05）。与术后3 个月相比，末次随访时，两组VAS、AOFAS 评分及背伸-跖屈ROM 均显著改善（P＜0.05）。术后3 个月，螺钉组AOFAS 评分[(83.6±4.9) vs (86.0±5.5), P=0.044] 显著低于钢板组，两组VAS 评分及踝背伸-跖屈ROM 的差异均无统计学意义（P＞0.05）；末次随访时，两组上述指标的差异均无统计学意义（P＞0.05）。影像方面，两组骨折复位质量、骨折愈合时间比较的差异均无统计学意义（P＞0.05）。[结论] 后前拉力螺钉与支撑钢板治疗Haraguchi Ⅰ型后踝骨折的复位质量、功能改善相当，后者相对手术时间长、术中出血量多，但其下地行走时间早。

Abstract:

[Objective] To compare the clinical outcomes of posterior-anterior lag screw versus buttress plate for fixation of Haraguchitype I posterior malleolus fractures. [Methods] A retrospective analysis was performed on 80 patients who received open reduction and in-ternal fixation (ORIF) for Haraguchi type I posterior malleolus fractures from June 2020 to September 2022. According to the doctor-pa-tient communication, 38 case had the posterior malleolus fractures fixed with the posterior-anterior lag screw (the screw group), while other42 cases were fixed with buttress plate (the plate group), with the combined lateral and medial malleolar fractures treated simultaneously.The perioperative, follow-up and imaging data of the two groups were compared. [Results] The screw group was significantly less than theplate group in terms of operative time [(69.5±4.6) min vs (90.2±6.4) min, P＜0.001], total incision length [(9.0±2.3) cm vs (10.3±2.6) cm, P=0.021] and intraoperative blood loss [(104.8±20.5) ml vs (116.0±21.3) ml, P=0.019], although the former resumed postoperative walking sig-nificantly later than the latter [(64.8±3.7) days vs (60.0±4.0) days, P=0.019]. There was no statistically significant difference in time to re-gain the full weight-bearing activity between the two groups (P＞0.05). Compared with those 3 months after surgery, the VAS, AOFASscores and dorsal-plantar flexion ROM in both groups were significantly improved at the last follow-up (P＜0.05). The screw group got sig-nificantly lower AOFAS score than the plate group 3 months after surgery [(83.6±4.9) vs (86.0±5.5), P=0.044], whereas there were no signifi-cant differences in VAS score and ankle-dorsal-plantar flexion ROM between the two groups (P＞0.05). At the last follow-up, there was nosignificant difference between the two groups in terms of any items abovementioned (P＞0.05). As for imaging, there were no significant dif-ferences in the quality of fracture reduction and healing time between the two groups (P＞0.05). [Conclusion] Both posterior-anterior lagscrew and buttress plate achieve comparable clinical consequences for fixation of Haraguchi type I posterior malleolus fractures. By compar-ison, the screw has shorter operation time and less intraoperative bleeding, but longer time to resume walking.