钢板与螺钉内固定治疗大块后踝骨折的疗效比较-外科学专业论文.docxVIP

山西医科大学硕士学位论文 山西医科大学硕士学位论文 I I 钢板与螺钉内固定治疗大块后踝骨折的疗效比较 摘 要 目的： 比较钢板固定与单纯空心拉力螺钉内固定在治疗大块后踝骨折时的疗效，为临床 工作提供参考。 方法： 选取自山西医科大学第二医院自2012年4月至2014年12月间，采用手术治疗涉及 踝关节面大于25%的后踝骨折患者54例。其中29例采用钢板固定（钢板组），其中男 性14例，女性15例,年龄18-69岁，平均年龄40.25岁。据Lauge-Hansen 分型标准：旋 后外旋III度9例，IV度13例；旋前外旋IV度7例。25例采用空心螺钉固定（螺钉组）， 其中男性14例，女性11例，年龄19-66岁，平均年龄40.44岁。据Lauge-Hansen 分型标 准：旋后外旋III度9例，IV度11例；旋前外旋IV度5例。术后定期随访并根据美国足踝 外科协会（AOFAS）的踝-后足评分标准评价踝关节功能。记录两种治疗方法患者关 节功能（术后1年AOFAS评分）、骨折愈合时间、完全负重时间及相关并发症等差异。 结果： 1例患者（钢板组）失随访，其余53例患者均获随访，随访时间10～16个月，平 均13.7个月。两组患者骨折愈合时间、完全负重时间比较差异无统计学意义（P＞0.05）， 但末次随访AOFAS评分比较差异有统计学意义（P＜0.05）。 结论： 对于骨折块累及踝关节面大于25%的后踝骨折，钢板及螺钉均为有效治疗方法。 但相比于单纯空心拉力螺钉固定，钢板可以使踝关节功能在早期得到最大限度恢复， 提高手术治疗效果。 II II 关键词：后踝；骨折；内固定方式 PAGE PAGE IV The comparison of therapeutic effect between the plate and the screws in the treatment of large posterior malleolaor fracture Abstract Objective: To observe the effectiveness of the buttress plate and the screws in the treatment of posterior malleolar fracture, provide the reference for clinical work. Methods: From April 2012 to December 2014, 54 patients with posterior malleolus fractures which involve more than 25% ankle joint were treated and followed up. There were 28 patients were treated with the the buttress plate,including 14 males and 15 females and their average age is 40.25 years (range from 18 to 69 years). According to Lauge-Hansen classification system, 9 cases and 13 cases were rated as supination-external rotation type III and type IV respectively,and 7 cases as pronation-external rotation type IV. Twenty-three patients were treated with the the screws,including 14 males and 11 females and their average age is 40.44 years (range from 19 to 66 years). There are 9 cases and 11 cases were rated as supination-external rotation type III and type IV respectively,and 5 cases as pronation-external rotation type IV，according to Lauge-Hansen classification system. Regular follow-up and assess their ankle function with the ankle hindfoot clinical rating system of