距下关节镜下克氏针空心螺钉内固定治疗McCrory-Bladin Ⅲ型距骨外侧突骨折的临床效果研究

Clinical effect of Kirschner wire and hollow screw internal fixation under subtalar arthroscopy for McCrory-Bladin type III fracture of the lateral process of the talus

摘要:

目的 分析距下关节镜下克氏针空心螺钉内固定治疗McCrory-Bladin Ⅲ型距骨外侧突骨折的临床效果。方法 选取2019年4月—2023年7月黄石市中医医院收治的61例McCrory-Bladin Ⅲ型骨外侧突骨折患者，按照不同手术方法将其分为对照组和观察组。对照组30例采取切开复位克氏针固定治疗，观察组31例采取距下关节镜下克氏针空心螺钉内固定治疗，对比两组治疗效果。结果 观察组手术前后美国足踝外科协会评分和视觉模拟评分的变化大于对照组（P <0.05）。观察组疼痛、关节活动度、跛行Hawkins评分均高于对照组（P <0.05），观察组骨折愈合时间和住院时间均短于对照组（P <0.05）。观察组术后6个月与术后1周足踝功能恢复状况FAAM-ADL和FAAM-S评分的下降程度均大于对照组（P <0.05）。观察组与对照组术后1、3、6个月的骨痂生长情况Leeds评分比较，结果 ①不同时间点Leeds评分比较，差异有统计学意义（P <0.05）；②观察组与对照组Leeds评分比较，差异有统计学意义（P <0.05），观察组Leeds评分较高，骨痂生长较好；③两组Leeds评分变化趋势比较，差异有统计学意义（P <0.05）。观察组并发症总发生率低于对照组（P <0.05）。结论 对McCrory-Bladin Ⅲ型骨外侧突骨折患者采取距下关节镜下克氏针空心螺钉内固定治疗，可显著加快骨痂生长，改善足踝功能，减轻患者疼痛，且并发症发生率较低。

Abstract:

Objective To analyze the clinical effect of Kirschner wire and hollow screw internal fixation under subtalar arthroscopy for McCrory-Bladin type III fracture of the lateral process of the talus.Methods A total of 61 patients with McCrory-Bladin type III fracture of the lateral process of the talus admitted to Huangshi Hospital of Traditional Chinese Medicine from April 2019 to July 2023 were selected. They were divided into the control group and the observation group based on different treatment methods. In the control group, 30 patients were treated with open reduction and Kirschner wire fixation, while 31 patients in the observation group were treated with Kirschner wire and hollow screw internal fixation under subtalar arthroscopy. The clinical effect of the two groups was compared.Results The differences of VAS scores 2 weeks after surgery and before surgery in the observation group were higher than those in the control group (P < 0.05), and the differences of AOFAS scores 2 weeks after surgery and before surgery in the observation group were lower than those in the control group (P < 0.05). The pain, limp, and ankle range of motion score as assessed by the Hawkins scoring system in the observation group were higher than those in the control group (P < 0.05), while the fracture healing time and length of hospital stay in the observation group were shorter than those in the control group (P < 0.05). The differences in the FAAM-ADL and FAAM-S scores 6 months after surgery and 1 week after surgery in the observation group were lower than those in the control group (P < 0.05). Comparison of Leeds scores in the observation group and the control group at 1 month, 3 months and 6 months after surgery exhibited that they were different among the time points (P < 0.05) and between the groups (P < 0.05). The observation group showed higher Leeds scores, indicating better growth of callus. The change trends of the Leeds scores were also different between the two groups (P < 0.05). The overall incidence of complications in the observation group was lower than that in the control group (P < 0.05).Conclusions For patients with McCrory-Bladin type III fracture of the lateral process of the talus, Kirschner wire and hollow screw internal fixation under subtalar arthroscopy significantly accelerates the growth of callus, improves foot and ankle function, reduces pain and lowers the complication rate.