[摘要]目的 探討切開復(fù)位內(nèi)固定后下脛腓聯(lián)合分離固定治療踝關(guān)節(jié)骨折的臨床效果。方法 選取2015年2月～2016年8月我院收治的踝關(guān)節(jié)骨折患者94例為研究對象，將其隨機分為對照組（未固定螺釘）與觀察組（固定螺釘），每組各47例。比較兩組患者臨床效果，術(shù)后不同時期下脛腓間隙（TBCS）、下脛腓重疊距離（TBOL）水平，術(shù)后TBCS、TBOL、踝關(guān)節(jié)功能評分及患者滿意度。結(jié)果 觀察組患者治療總有效率為93.62%，對照組治療總有效率為68.08%，差異有統(tǒng)計學(xué)意義（χ2=9.8947，P<0.05），經(jīng)X線攝片結(jié)果顯示，兩組患者術(shù)后1、12個月TBCS、TBOL較術(shù)前均有明顯改善，兩組術(shù)后12個月與術(shù)后1個月TBCS、TBOL，差異無統(tǒng)計學(xué)意義（P>0.05），術(shù)后不同時期TBOL組間比較差異有統(tǒng)計學(xué)意義（P<0.05）；術(shù)后1個月TBCS組間比較，差異無統(tǒng)計學(xué)意義（P>0.05）；術(shù)后12個月TBCS組間比較差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組患者術(shù)后TBCS、TBOL、踝關(guān)節(jié)功能評分分別為（3.49±0.23）mm、（8.55±0.18）mm、（89.7±6.7）分，對照組患者術(shù)后TBCS、TBOL、踝關(guān)節(jié)功能評分分別為（3.62±0.39）mm、（8.15±0.23）mm、（80.3±4.9）分，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組患者治療后滿意率為97.87%，明顯高于對照組的82.98%，差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 切開復(fù)位內(nèi)固定后下脛腓聯(lián)合分離固定治療踝關(guān)節(jié)骨折有利于關(guān)節(jié)面解制復(fù)位，有利于更好地治療軟骨和韌帶損傷，提高臨床手術(shù)的治療效果，該方法值得在臨床上推廣應(yīng)用。
　　[關(guān)鍵詞]復(fù)位內(nèi)固定；下脛腓；分離固定；踝關(guān)節(jié)骨折；臨床療效
　　[中圖分類號] R687.3 [文獻標(biāo)識碼] A [文章編號] 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.

相關(guān)熱詞搜索：固定 復(fù)位 切開 骨折 臨床