切开复位内固定后下胫腓联合分离固定治疗踝关节骨折的临床效果分析

　　[摘要]目的 探討切开复位内固定后下胫腓联合分离固定治疗踝关节骨折的临床效果。方法 选取2015年2月～2016年8月我院收治的踝关节骨折患者94例为研究对象，将其随机分为对照组（未固定螺钉）与观察组（固定螺钉），每组各47例。比较两组患者临床效果，术后不同时期下胫腓间隙（TBCS）、下胫腓重叠距离（TBOL）水平，术后TBCS、TBOL、踝关节功能评分及患者满意度。结果 观察组患者治疗总有效率为93.62%，对照组治疗总有效率为68.08%，差异有统计学意义（χ2=9.8947，P<0.05），经X线摄片结果显示，两组患者术后1、12个月TBCS、TBOL较术前均有明显改善，两组术后12个月与术后1个月TBCS、TBOL，差异无统计学意义（P>0.05），术后不同时期TBOL组间比较差异有统计学意义（P<0.05）；术后1个月TBCS组间比较，差异无统计学意义（P>0.05）；术后12个月TBCS组间比较差异有统计学意义（P<0.05）。观察组患者术后TBCS、TBOL、踝关节功能评分分别为（3.49±0.23）mm、（8.55±0.18）mm、（89.7±6.7）分，对照组患者术后TBCS、TBOL、踝关节功能评分分别为（3.62±0.39）mm、（8.15±0.23）mm、（80.3±4.9）分，两组比较差异有统计学意义（P<0.05）。观察组患者治疗后满意率为97.87%，明显高于对照组的82.98%，差异有统计学意义（P<0.05）。结论 切开复位内固定后下胫腓联合分离固定治疗踝关节骨折有利于关节面解制复位，有利于更好地治疗软骨和韧带损伤，提高临床手术的治疗效果，该方法值得在临床上推广应用。
　　[关键词]复位内固定；下胫腓；分离固定；踝关节骨折；临床疗效
　　[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-4721（2018）2（b）-0035-03
　　Analysis of clinical effect of open reduction and internal fixation of lower tibiofibula plus separation and fixation in the treatment of ankle fracture
　　ZHANG Ze JIN Yun-long
　　Department of Orthopedics，Shenyang 739th Hospital，Liaoning Province，Shenyang 110021，China
　　[Abstract]Objective To investigate the clinical effect of open reduction and internal fixation of lower tibiofibula plus separation and fixation in the treatment of ankle fracture.Methods Altogether 94 patients with ankle fracture who were treated in our hospital from February 2015 to August 2016 were selected as the object of this research and randomly divided into control group （without fixed screws） and observation group （with fixed screws），47 cases in each group.The clinical efficacy，tibiofibular clear space （TBCS） and tibiofibular overlap （TBOL） at different post-operative periods，post-operative TBCS，TBOL，ankle function score and patients′satisfaction were compared between the two groups.Results The total effective rate of observation group was 93.62% versus 68.08% in the control group，with statistically significant difference between two groups （χ2=9.8947，P<0.05）；X-ray examination showed that the TBCS and TBOL of two groups at post-operative 1 and 12 months were significantly improved in comparison with those before operation，without statistically significant difference （P>0.05）；TBOL at different post-operative periods had statistically significant difference between two groups （P<0.05）；TBCS at post-operative 1 month had no statistically significant difference between two groups （P>0.05）；TBCS at post-operative 12 months were significant difference between two groups（P<0.05）.The post-operative TBCS， TBOL and ankle function scores of observation group were （3.49±0.23） mm，（8.55±0.18） mm and （89.7±6.7） points versus （3.62±0.39） mm，（8.15±0.23） mm and （80.3±4.9） points in the control group，with statistically significant difference between two groups（P<0.05）.The patients′satisfaction rate of the observation group was 97.87%，significantly higher than that of the control group （82.98%），with statistically significant difference between the two groups （P<0.05）.Conclusion Open reduction and internal fixation of lower tibiofibula plus separation and fixation in the treatment of ankle fracture is beneficial to the reduction of articular surface，better treatment of cartilage and ligament injury，and improves the effect of clinical operations，which is worthy of clinical application.

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