微型钢板与空心钉内固定治疗后踝大块骨折患者术后关节功能恢复效果的比较

doi:10.3969/j.issn.1006-5725.2024.18.011

Abstract

Abstract:

Objective To analyze the impact of mini plate and cannulated screw internal fixation on joint function recovery in patients with posterior malleolus fracture. Methods A total of 150 patients with posterior malleolus fractures， treated at our hospital from March 2021 to June 2023， were included in this study. They were divided into two groups using the odd-even number method. The control group consisted of 75 patients who underwent cannulated screw internal fixation， while the study group comprised 75 patients who received mini plate internal fixation. Clinical indicators， ankle range of motion， ankle function， and health status were compared and analyzed between the two groups. Additionally， levels of inflammatory factors， postoperative complications， and clinical efficacy were assessed. Results In terms of operation time and intraoperative blood loss， there was no statistically significant difference between the two groups （P > 0.05）. However， the study group exhibited shorter ambulation days， fracture healing time， and hospitalization days compared to the control group （P < 0.05）. Moreover， the study group demonstrated significantly improved ankle dorsiflexion， ankle plantar flexion， foot varus and foot valgus range of motion compared to the control group （P < 0.05）. Additionally， higher AOFAS score and KPS score were observed in the study group as compared to the control group （P < 0.05）. Furthermore， levels of IL-6， IL-8 and CRP were lower in the study group than in the control group （P < 0.05）. The incidence of postoperative complications was also lower in the study group than in the control group （P < 0.05）. Conclusion Mini plate internal fixation for posterior malleolus fracture yields ideal outcomes by promoting improvement in clinical indicators and ankle range of motion while effectively enhancing ankle function， reducing inflammatory reaction as well as minimizing postoperative complications.

Key words: posterior malleolus fracture, mini plate internal fixation, cannulated screw internal fixation, joint function

CLC Number:

R683

Junjie FAN,Xiao YU,Feng LV,Weidong WU,Jun SHEN,Li. SUN. Effect of internal fixation with mini plate and cannulated screw on postoperative recovery of joint function in patients with large fracture of posterior malleolus[J]. The Journal of Practical Medicine, 2024, 40(18): 2571-2577.

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References 25

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组别	例数	男/女	平均年龄（x ± s）/岁	骨折原因			病灶部位		骨折分型
组别	例数	男/女	平均年龄（x ± s）/岁	摔伤	交通事故伤	扭伤	左踝	右踝	Ⅲ型	Ⅳ型
对照组	75	40/35	43.58 ± 3.16	30	34	11	38	37	50	25
观察组	75	41/34	43.68 ± 3.52	31	35	9	40	35	52	23
t/χ²值		0.027	-0.096	0.231			0.107		0.123
P值		0.870	0.924	0.891			0.744		0.726

组别	例数	手术时间/min	术中出血量/mL	下床活动时间/d	骨折愈合时间/周	住院时间/d
观察组	75	70.35 ± 10.22	52.39 ± 12.01	7.13 ± 1.02	7.22 ± 1.34	8.62 ± 2.03
对照组	75	68.49 ± 9.36	53.26 ± 11.89	9.85 ± 2.36	9.46 ± 2.38	11.59 ± 2.94
t值		1.361	0.446	9.162	7.102	7.199
P值		0.176	0.656	< 0.001	< 0.001	< 0.001

时间段	组别	踝关节背伸	踝关节跖屈	足部内翻	足部外翻
手术前	观察组	5.43 ± 1.08	16.22 ± 1.47	8.24 ± 1.06	13.29 ± 1.34
	对照组	5.46 ± 1.07	16.24 ± 1.45	8.25 ± 1.04	13.34 ± 1.32
	t值	0.171	0.084	0.058	0.230
	P值	0.865	0.933	0.954	0.818
手术治疗1周后	观察组	9.28 ± 1.39^?	27.93 ± 1.85^?	3.16 ± 1.05^?	5.11 ± 1.02^?
	对照组	7.26 ± 1.33^?	24.33 ± 2.03^?	5.28 ± 1.03^?	7.16 ± 1.35^?
	t值	9.093	11.036	12.482	10.492
	P值	< 0.001	< 0.001	< 0.001	< 0.001
手术治疗3个月后	观察组	11.03 ± 0.25^?	29.47 ± 1.05^?	2.03 ± 0.11^?	4.16 ± 0.33^?
	对照组	9.26 ± 0.37^?	26.44 ± 1.67^?	4.29 ± 0.58^?	5.24 ± 0.47^?
	t值	34.327	13.302	33.154	16.287
	P值	< 0.001	< 0.001	< 0.001	< 0.001

时间段	组别	AOFAS评分	KPS评分
手术前	观察组	26.38 ± 4.29	53.11 ± 8.25
	对照组	26.37 ± 4.25	53.10 ± 8.22
	t值	0.014	0.007
	P值	0.989	0.994
手术治疗1周后	观察组	74.89 ± 11.36^?	86.59 ± 11.63^?
	对照组	60.22 ± 9.58^?	74.33 ± 10.38^?
	t值	8.549	6.811
	P值	< 0.001	< 0.001
手术治疗3个月后	观察组	89.63 ± 5.29^?	90.37 ± 6.24^?
	对照组	74.11 ± 6.28^?	82.59 ± 5.36^?
	t值	16.389	8.191
	P值	< 0.001	< 0.001

时间段	组别	IL-6/（pg/L）	IL-8/（pg/L）	CRP/（mg/L）
手术前	观察组	113.58 ± 18.62	59.84 ± 10.63	205.63 ± 30.11
	对照组	113.27 ± 18.65	59.86 ± 10.57	205.47 ± 30.15
	t值	0.102	0.012	0.033
	P值	0.919	0.991	0.974
手术治疗1周后	观察组	73.22 ± 6.58^?	34.22 ± 4.33^?	103.29 ± 18.22^?
	对照组	90.84 ± 10.22^?	41.59 ± 7.63^?	135.97 ± 21.57^?
	t值	12.554	7.275	10.024
	P值	< 0.001	< 0.001	< 0.001
手术治疗3个月后	观察组	54.29 ± 3.11^?	21.33 ± 1.52^?	76.59 ± 6.47^?
	对照组	68.47 ± 5.29^?	30.58 ± 2.64^?	84.37 ± 10.22^?
	t值	20.012	26.297	5.570
	P值	< 0.001	< 0.001	< 0.001

Effect of internal fixation with mini plate and cannulated screw on postoperative recovery of joint function in patients with large fracture of posterior malleolus

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组别	例数	切口感染	延迟愈合	钉断裂	钉松动	合计
观察组	75	2（2.67）	1（1.33）	0（0.00）	0（0.00）	3（4.00）
对照组	75	4（5.33）	2（2.67）	2（2.67）	2（2.67）	10（13.33）
χ ² 值						5.500
P值						0.019

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