AO/OTA 44-B型踝关节骨折的微创与切开腓骨远端钢板固定术对比

Minimally Invasive Versus Open Distal Fibular Plating for AO/OTA 44-B Ankle Fractures.

作者信息

Chiang Chao-Ching, Tzeng Yun-Hsuan, Lin Chun-Cheng, Huang Ching-Kuei, Chang Ming-Chau

机构信息

Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan

Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei, Taiwan.

出版信息

Foot Ankle Int. 2016 Jun;37(6):611-9. doi: 10.1177/1071100715625292. Epub 2016 Jan 5.

DOI:10.1177/1071100715625292

PMID:26740306

Abstract

BACKGROUND

Open reduction and internal fixation (ORIF), the standard treatment for unstable ankle fractures, has well-known wound complications. Minimally invasive surgery (MIS) has been proposed to decrease these complications. The objectives of this study were to describe an algorithm of MIS for fibular plating and compare the radiographic restoration of fibular anatomy, functional outcomes, and complications between ORIF and MIS for ankle fractures.

METHODS

This retrospective study included 71 patients with AO/OTA 44-B ankle fractures treated by a single surgeon. ORIF group consisted of 34 patients (54.5-month follow-up) and MIS group was composed of 37 patients (55.9-month follow-up). Among 37 MIS patients, 13 patients were treated with minimally invasive percutaneous plate osteosynthesis and 24 patients with minimally invasive trans-fracture approach according to our MIS algorithm. Operative outcomes were evaluated and compared between the 2 groups by radiographic measurements, functional assessment, and complications.

RESULTS

The MIS group had less blood loss but longer operative time and greater exposure to fluoroscopy. Radiographic measurements revealed similar union time, fibular length, talocrural angle, medial clear space, and tibiofibular clear space in both groups. Lower visual analogue pain score was observed in the MIS group in the early postoperative period. At last follow-up, there were no significant differences regarding pain score, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, and range of motion between the 2 groups. Total complication rate was significantly higher in the ORIF group.

CONCLUSION

Patients with AO/OTA 44-B fractures treated with MIS fibular plating achieved similar radiographic and functional outcomes but had less pain in the early postoperative period and fewer wound complications compared with those treated with ORIF.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

背景

切开复位内固定术（ORIF）是不稳定踝关节骨折的标准治疗方法，但其伤口并发症众所周知。有人提出采用微创手术（MIS）来减少这些并发症。本研究的目的是描述一种用于腓骨钢板固定的MIS算法，并比较ORIF和MIS治疗踝关节骨折时腓骨解剖结构的影像学恢复情况、功能结局及并发症。

方法

本回顾性研究纳入了由同一位外科医生治疗的71例AO/OTA 44 - B型踝关节骨折患者。ORIF组有34例患者（随访54.5个月），MIS组由37例患者组成（随访55.9个月）。在37例MIS患者中，根据我们的MIS算法，13例患者采用微创经皮钢板接骨术治疗，24例患者采用微创经骨折入路治疗。通过影像学测量、功能评估和并发症情况对两组的手术结局进行评估和比较。

结果

MIS组失血量较少，但手术时间较长，接受透视的时间更多。影像学测量显示两组的愈合时间、腓骨长度、胫距关节角、内侧间隙和胫腓间隙相似。术后早期MIS组的视觉模拟疼痛评分较低。在最后一次随访时，两组在疼痛评分、美国矫形足踝协会踝 - 后足评分及活动范围方面无显著差异。ORIF组的总并发症发生率显著更高。