由前向后与由后向前置入拉力螺钉 治疗后踝骨折的对比

Comparison of anteroposterior and posteroanterior lag screw placements for fixation of posterior malleolar frac⁃tures

摘要:

比较经皮由前向后与由后向前置入拉力螺钉治疗三踝骨折中后踝骨折方法及临床疗效。［方法］ 2013 年 1 月~2017 年 6 月本院骨科收治的 HaraguchiI 型后踝骨折病人 49 例，按治疗方法，24 例采用经皮由前向后 螺钉内固定后踝骨折，25 例采取后外侧入路有限暴露并复位螺钉内固定后踝骨折。比较两组患者围手术期、随访结 果与影像资料。［结果］ 两组患者均顺利完成手术。两组在手术时间的差异无统计学意义 （P>0.05）；前方螺钉组透 视次数显著多于后方螺钉组 （P<0.05）；前方螺钉组腓骨侧切口长度显著短于后方螺钉组 （P<0.05）；前方螺钉组失 血量显著小于后方螺钉组 （P<0.05）。平均随访时间 （17.61±3.85） 个月。两组在完全负重行走时间的差异无统计学 意义 （P>0.05）。随术后时间推移，两组患者的 AOFAS 评分均显著增加，不同时间点间差异均有统计学意义 （P< 0.05）；但术后 6、12 个月及末次随访时两组患者的 AOFA 评分差异均无统计学意义 （P>0.05）。末次随访时两组患 者间踝关节 ROM 差异均无统计学意义 （P>0.05）。术后影像显示前方螺钉组 5 例关节面复位不良，而后方螺钉组 2 例关节面复位不良。两组患者的骨折愈合时间差异无统计学意义 （P>0.05）。［结论］ 经皮前方螺钉内固定及后外侧 入路螺钉内固定后踝骨折均可治疗三踝骨折，后者复位及固定质量优于前者。

Abstract:

[Objective] To compare clinical outcome of percutaneous anteroposterior lag screw versus open posteroanterior lag screw for fixation of Haraguchi type I posterior malleolar fractures. [Methods] Between January 2013 and June 2017, 49 pa? tients who underwent surgical treatment for posterior malleolar fractures enrolled into this study. Based on orientations of lag screw placed, 24 patients had percutaneous lag screws placed anterior-posteriorly (the AP group) , while the remaining 25 pa? tients had open screw inserted posterior-anteriorly (the PA group) for fixation of posterior malleolar fractures. The periopera? tive, follow-up and radiographic documentations were compared between the two groups. [Results] All patients had surgical pro? cedures performed smoothly. Although no a statistical difference was proved in operation time between the two groups (P>0.05) , the AP group had significantly more frequency of fluoroscopy, significantly shorter fibular incision length, and significantly less intraoperative blood loss than the PA group (P<0.05) . The follow-up period lasted for (17.61±3.85) months on average. There was no a statistically significant difference in time to return to full-weight bearing ambulation between the two group [(88.13± 9.47) days vs (87.84±8.74) days, P>0.05] . As time went the AOFAS score in both group significantly increased (P<0.05) , nev? ertheless no significant differences in AOFAS score were noticed between the two groups at 6, 12 months and the latest follow up (P>0.05) . In addition, there were no statistical differences in ankle ROMs between them at the latest follow up (P>0.05) . Re? garding to radiographic assessment, improper reduction was revealed by postoperative radiographs in 5 / 24 of the AP group, whereas 2/25 of the PA group, despite of no a statistical difference between the two group in fracture healing time (P>0.05) . [Conclusion] Both AP and PA lag screw placements are efficient technique for fixation of posterior malleolar fractures, however, the former might be inferior to latter in fracture reduction and fixation.