空心钉与支撑钢板固定后踝骨折块的比较（开放获取）

Cannulated screws versus support plate for fixation of posterior malleolus fracture fragment

摘要:

[目的] 比较空心钉固定和支撑钢板固定三踝骨折和后踝骨折块的临床疗效。[方法] 回顾性分析2018 年2 月-2021年2 月68 例三踝骨折患者的临床资料。根据医患沟通结果，41 例采用空心钉固定后踝骨块，另外27 例采用支撑钢板固定。比较两组围手术期指标、随访及影像资料。[结果] 两组手术时间、切口长度、术中出血量、术中透视次数、切口愈合等级、住院时间、下地行走时间、切口感染、血管栓塞事件的差异均无统计学意义（P＞0.05）。空心钉组的趾屈曲挛缩[例(%), 2 (4.9)vs 7 (25.9), P=0.012] 及内置物激惹[例(%), 3 (7.3) vs 11 (40.7), P＜0.001] 的发生率显著优于支撑板组。与术后3 个月相比，末次随访时，两组VAS 评分、AOFAS 评分及踝背伸/跖屈ROM 均显著改善（P＜0.05）。相应时间点，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、骨愈合、创伤性关节炎发生情况的差异均无统计学意义（P＞0.05）。与术前相比，末次随访时，两组TFCS 、MCS 均显著减小（P＜0.05），相应时间点，两组间TFCS 、MCS 的差异均无统计学意义（P＞0.05）。[结论] 空心钉和支撑钢板均可有效固定后踝骨折块，获得满意的踝关节功能，但需随访创伤后关节炎的进展。与支撑钢板固定相比，空心钉固定操作更简单有效，内置物相关并发症更少。

Abstract:

[Objective] To compare the clinical efficacy of cannulated screw fixation versus support plate fixation of the posterior malle-olar fracture fragment in the trimalleolar fractures. [Methods] A retrospective study was done on 68 patients who received surgical treat-ment for trimalleolar fractures from February 2018 to February 2021. According to the surgeon-patient communication, 41 patients had theposterior malleolus fragment fixed with cannulated screws (CS), while the other 27 patients were fixed with support plates (SP). The data re-garding to perioperative period, follow-up and images were compared between the two groups. [Results] There were no significant differenc-es in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, incision healing grade, hospitalstay, walking time, occurrences of incision infection and thrombosis events between the two groups (P＞0.05). However, the CS group provedsignificantly superior to the SP group in terms of incidence of toe flexion contracture [case (%), 2 (4.9) vs 7 (25.9), P=0.012] and implant irri-tation [case (%), 3 (7.3) vs 11 (40.7), P＜0.001]. Compared with those 3 months after surgery, the VAS score, AOFAS score and ankle-dorsi-flexion/plantar flexion ROM in both groups were significantly improved at the last follow-up (P＜0.05), whereas which were not statisticallysignificant at any corresponding time points between the two groups (P＞0.05). Radiographically, there were no statistically significant differ-ences in the quality of fracture reduction, bone healing and traumatic arthritis between the two groups (P＞0.05). The tibiofibular clear space(TFCS) and medial clear space (MCS) in both groups were significantly decreased at the last follow-up compared with those preoperatively(P＞0.05), while there were no significant differences in TFCS and MCS between the two groups at corresponding time points (P＞0.05).[Conclusion] Both cannulated screws and support plates do effectively fix posterior malleolus fracture, and achieve satisfactory clinical con-sequences, despite that the progression of post-traumatic arthritis needs to be furtherly followed up. Compared with support plate fixation,cannulated screw fixation is simpler and more effective, with fewer implant-related complications.