踝关节镜联合闭合复位导向器与切开复位治疗三踝骨折的疗效比较

doi:10.11958/20240936

摘要/Abstract

摘要：

目的比较踝关节镜联合闭合复位导向器与常规手术切开治疗三踝骨折的临床疗效。方法纳入60例三踝骨折患者并根据其接受的手术方式分为踝关节镜联合闭合复位导向器手术组（关节镜组）和常规切开手术组（切开组），每组30例。观察并比较2组患者手术时间、术中出血量及并发症情况，采用美国足踝外科协会（AOFAS）踝与后足评分和伤残指数评分（FADI）评价患者的疼痛和功能恢复情况。结果与关节镜组比，切开组的手术时间延长，内踝侧切口长度减小，出血量减少，皮肤麻木比例下降（P<0.05）。关节镜组术后12个月AOFAS总分和FADI评分高于切开组（P<0.05）。关节镜组内无软骨损伤患者术后12个月AOFAS评分高于有软骨损伤患者（P<0.05），而有无软骨损伤的患者间疼痛及力线评分差异无统计学意义（P>0.05）。结论应用踝关节镜技术联合闭合复位导向器治疗三踝骨折能够使患者获得更好的术后疗效，但和切开术式相比，其在手术时间、切口感染方面无明显优势。

关键词: 踝骨折, 关节镜检查, 闭合复位导向器, 软骨损伤, 疗效评价

Abstract:

Objective To compare the clinical efficacy of ankle arthroscopy combined with closed reduction guide and conventional surgical incision in the treatment of trimalleolar fracture. Methods A total of 60 patients with ankle fracture were divided into two groups according to different surgical plans: the ankle arthroscopy combined with closed reduction guide surgery group (arthroscopy group) and the conventional incision surgery group (incision group), with 30 cases in each group. The operative time, intraoperative blood loss and complications of the two groups were observed and compared. Pain and functional recovery of patients were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hind foot scores and Foot and Ankle Disability Index (FADI) scores. Results All 60 patients were followed up. Compared with the arthroscopy group, patients in the incision group had a longer surgical time, a shorter incision length in the medial malleolus, a reduced number of cases of skin numbness and reduced bleeding (P<0.05). The AOFAS score and the FADI score at 12 months after surgery were higher in the arthroscopic group than those of the incision group (P<0.05). After 12 months of surgery, the AOFAS score in patients without cartilage injury of the arthroscopic group were higher than those of patients with cartilage injury (P<0.05), while there were no significant differences in pain and force line scores between patients with cartilage injury and patients without cartilage injury (P>0.05). Conclusion The application of ankle arthroscopy combined with closed reduction guide in the treatment of trimalleolar fracture can achieve better postoperative results, but it has no obvious advantages in operation time and incision infection compared with the incision surgery.

Key words: ankle fractures, arthroscopy, closed reduction guide, cartilage injury, efficacy evaluation

中图分类号:

R683.42

图/表 6

表1 2组术前资料比较

Tab.1 Comparison of preoperative data between the two groups

组别	n		年龄/岁		性别（男/女）	侧别（左/右）		Lauge-Hansen
组别	n		年龄/岁		性别（男/女）	侧别（左/右）		旋前外旋Ⅳ°		旋后外旋Ⅳ°
切开组	30		41.5±9.1		19/11	16/14		7（23.33）		23（76.67）
关节镜组	30		42.3±9.9		20/10	17/13		5（16.67）		25（83.33）
t或χ²			0.354		0.073	0.067		0.417
组别		致伤原因					伤后至手术时间/d		随访时间/月
组别		扭伤		交通事故			伤后至手术时间/d		随访时间/月
切开组		23（76.67）		7（23.33）			6.33±1.18		11.96±0.76
关节镜组		20（66.67）		10（33.33）			6.86±1.33		12.26±0.82
t或χ²		0.739					1.639		1.458

表2 2组患者术后一般资料比较

Tab.2 Comparison of postoperative general data between the two groups

组别			并发症
组别			切口感染		血管损伤		皮肤麻木
切开组			3		1		8
关节镜组			1		0		2
χ²或P			0.268		1.000^▲		4.320^＊
组别	n	手术时间/min		内踝切口长度/cm		术中出血量/ mL
切开组	30	55.73±9.47		5.72±0.67		58.60±9.69
关节镜组	30	62.53±10.32		1.30±0.34		51.80±10.65
t		2.658^＊＊		31.840^＊＊		2.585^＊＊

图1 关节镜联合闭合复位导向器手术治疗踝关节骨折患者男，45岁，扭伤致左踝关节骨折。A、B：闭合复位导向器外观（专利号：201820815470.7，导向器由内管、外管、滑动栓、弧形轨道和复位钳组成，其可调整角度，更适用于踝关节，刻度值也更加精细）；C：切开并固定腓骨；D：关节镜入路；E、F：复位导向器辅助固定下胫腓联合；G：复位导向器辅助固定内踝骨折；H、I：镜下查看骨折平面，可见骨折线及软骨损伤；J：镜下复位显示关节面平整；K、L：术后外观。

Fig.1 Arthroscopy combined with closed reduction guide surgical treatment of ankle fracture

表3 2组患者术后12个月AOFAS评分比较（分，$\bar{x} \pm s$）

Tab.3 Comparison of AOFAS scores 12 months after operation between two groups of patients

组别	n	疼痛	功能	力线	总分
切开组	30	36.33±4.90	41.16±4.21	8.83±2.15	86.33±6.31
关节镜组	30	36.66±4.79	43.60±4.71	9.50±1.52	89.93±5.88
t		0.266	2.108^＊	1.385	2.284^＊

表4 关节镜组中软骨有无损伤患者术后12个月AOFAS评分比较（分，$\bar{x} \pm s$）

Tab.4 Comparison of AOFAS scores between arthroscopic patients with and without cartilage injury 12 months after operation

软骨损伤情况	n	疼痛	功能	力线	总分
无损伤	21	37.14±4.62	44.57±4.30	9.52±1.50	91.23±5.13
有损伤	9	35.55±5.27	39.55±5.29	9.44±1.66	84.55±4.24
t		0.826	2.730^＊	0.128	3.424^＊＊

表5 2组患者术后12个月FADI评分比较（分，$\bar{x} \pm s$）

Tab.5 Comparison of FADI scores 12 months after operation between two groups of patients

组别	n	疼痛	功能	总分
切开组	30	14.96±1.29	76.33±4.77	91.30±5.13
关节镜组	30	15.03±0.96	79.16±4.19	94.20±4.12
t		0.226	2.442^＊	2.413^＊

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