3种钢板内固定手术在HaraguchiⅡ型后踝骨折中的临床应用

Clinical application of three types of plate internal fixation for Haraguchi type II posterior malleolus fractures

摘要:

目的 对比改良纵向弧形切口后内侧、后外联合后内侧、跟腱旁后内侧入路钢板内固定在Haraguchi Ⅱ型后踝骨折中临床应用。方法 回顾性分析2020年3月—2022年2月中国人民解放军联勤保障部队第九〇四医院收治的127例Haraguchi Ⅱ型后踝骨折患者的临床资料，以随机数字表法分为A组（42例）、B组（43例）和C组（42例）。A组行后外联合后内侧入路钢板内固定治疗，B组行跟腱旁后内侧入路钢板内固定治疗，C组行改良纵向弧形切口后内侧入路钢板内固定治疗。对比3组围手术期资料、手术效果、骨折复位质量、骨折愈合时间及并发症。结果 B、C组术中失血量少于A组（P <0.05）。3组手术时间和切口愈合等级比较，差异均无统计学意义（P >0.05）。3组术后3个月和术后2年视觉模拟评分法和美国足踝外科协会评分比较，差异均无统计学意义（P >0.05）。3组完全负重时间、踝屈伸-跖屈活动度（ROM）、踝屈伸-背屈ROM比较，差异均无统计学意义（P >0.05）。B、C组骨折复位质量优于A组（P <0.05），B、C组骨折愈合时间短于A组（P <0.05）。A组并发症总发生率最高（P <0.012 5），C组并发症总发生率最低（P <0.012 5）。结论 相比于后外联合后内侧入路，改良纵向弧形切口后内侧、跟腱旁后内侧入路钢板内固定可降低Haraguchi Ⅱ型后踝骨折患者并发症发生风险，提高复位质量，缩短骨折愈合时间，并减轻手术创伤。

Abstract:

Objective To compare the effect of modified longitudinal curved incision posteromedial, combined posteromedial and posterolateral, and Achilles tendon-splitting posteromedial approaches for plate internal fixation in treating Haraguchi type II posterior malleolus fractures.Methods Clinical data of 127 patients with Haraguchi type II posterior malleolus fractures admitted to the 904th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from March 2020 to February 2022 were retrospectively analyzed. The patients were divided into group A (n = 42), group B (n = 43) and group C (n = 42) by the random number table method. Group A was treated with the combined posteromedial and posterolateral approach, group B was treated with the Achilles tendon-splitting posteromedial approach, and group C was treated with modified longitudinal curved incision posteromedial approach. The perioperative data, surgical outcomes, quality of fracture reduction, fracture healing time and complications of the three groups were compared.Results The intraoperative blood loss in group B and group C was lower than that in group A (P < 0.05). There was no statistically significant difference in the operative duration and the incision healing grade among the groups (P > 0.05). There were no statistically significant differences in the Visual Analogue Scale (VAS) scores and the American Orthopaedic Foot & Ankle Society (AOFAS) scores at 3 months and 2 years after surgery among the groups (P > 0.05). There were no statistically significant differences among the three groups in time to full weight-bearing, ankle flexion - plantarflexion range of motion (ROM), or ankle flexion - dorsiflexion ROM (P > 0.05). The quality of fracture reduction in groups B and C was significantly better than that in group A (P < 0.05), and the time to fracture union was significantly shorter in groups B and C than in group A (P < 0.05). Group A had the highest overall complication rate (P < 0.012 5), whereas group C had the lowest (P < 0.012 5).Conclusion Compared with the combined posteromedial and posterolateral approach, the modified longitudinal curved incision posteromedial and Achilles tendon-splitting posteromedial approaches can reduce the risk of complications, improve reduction quality, shorten fracture healing time, and mitigate surgical trauma in patients with Haraguchi type II posterior malleolar fractures.