用于开放性和闭合性踝关节骨折的腓骨钉：来自非设计型一级重大创伤中心的结果。
Fibular nails for open and closed ankle fractures: Results from a non-designer level I major trauma centre.
作者信息
Al-Obaidi Bilal, Wiik Anatole Vilhelm, Bhattacharyya Rahul, Mushtaq Nadeem, Bhattacharya Rajarshi
机构信息
Department of Trauma and Orthopaedics, Division of Surgery and Cancer, Imperial College Healthcare NHS Trust, North West London Major Trauma Centre, London, UK.
出版信息
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019832420. doi: 10.1177/2309499019832420.
AIM
To evaluate the outcome of a fibular nail in the treatment of open and closed unstable ankle fractures in a non-designer centre.
METHODS
In a retrospective cohort study, a total of 39 ankle fractures (14 open and 25 closed) treated with a locking fibular nail were evaluated between 2012 and 2015 in a non-designer level I major trauma centre. Post-operative radiographs were analysed to assess the quality of reduction (McLennan and Ungersma marking system), fracture union and complications. Three patient reported outcome scores (Olerud and Molander score (OMAS), American Association of Orthopaedic Surgeons (AAOS) foot and ankle score and 12-Item Short Form Survey (SF-12)) were collected to obtain an overall measure of the patient's physical and mental outcome.
RESULTS
The adequacy of reduction data was available for 38 of 39 cases; 33 (87%) achieved good, 3 (8%) fair and 2 (5%) poor ratings, based on the McLennan and Ungersma marking system. Thirty-five (12 open and 23 closed) patients were available for initial follow-up. Five (14.3%) of 35 had documented complications (2 of 12 in the open cohort and 3 of 23 in the closed cohort). All fibular fractures treated with the fibular nail went on to unite. Twenty-three (66%) of 35 patients were available at 1-year follow-up for measurement of objective outcome. The combined mean OMAS for both groups was 53.7 (0-85) with statistically better results (59.5 (25-85) vs. 37.3 (0-75)) in favour of the closed versus open injuries, respectively. The mean AAOS score was also statistically better for the closed group than the open, 70.3 (30-95) versus 46.6 (20-77), respectively. The mean SF-12 score (physical component) was 40 (21.6-52.4) in the closed group versus 36.1 (19.4-51.5) in the open group; the mean mental component was 42.5 (26.6-54.3) in the closed group versus 38.8 (28.4-60.5) in the open group, these however were not statistically different.
CONCLUSION
Fibular nails are an effective alternative for the treatment for both closed and open unstable ankle fractures with soft tissue compromise.
目的
在非高级别中心评估腓骨钉治疗开放性和闭合性不稳定踝关节骨折的疗效。
方法
在一项回顾性队列研究中，2012年至2015年期间，在一家非高级别的I级主要创伤中心对39例采用锁定腓骨钉治疗的踝关节骨折（14例开放性骨折和25例闭合性骨折）进行了评估。分析术后X线片以评估复位质量（麦克伦南和昂格斯马评分系统）、骨折愈合情况及并发症。收集三项患者报告结局评分（奥勒鲁德和莫兰德评分（OMAS）、美国矫形外科医师协会（AAOS）足踝评分以及12项简明健康调查（SF - 12）），以全面衡量患者的身心结局。
结果
39例中有38例可获得复位充分性数据；根据麦克伦南和昂格斯马评分系统，33例（87%）复位良好，3例（8%）尚可，2例（5%）较差。35例患者（12例开放性骨折和23例闭合性骨折）可进行初始随访。35例中有5例（14.3%）记录有并发症（开放性骨折队列中的12例中有2例，闭合性骨折队列中的23例中有3例）。所有用腓骨钉治疗的腓骨骨折均实现愈合。35例患者中有23例（66%）在1年随访时可进行客观结局测量。两组的综合平均OMAS为53.7（0 - 85），闭合性损伤组的结果在统计学上更好（分别为59.5（25 - 85）和37.3（0 - 75））。闭合组的平均AAOS评分在统计学上也优于开放组，分别为70.3（30 - 95）和46.6（20 - 77）。闭合组的平均SF - 12评分（身体成分）为40（21.6 - 52.4），开放组为36.1（19.4 - 51.5）；闭合组的平均心理成分评分为42.5（从26.6至54.3），开放组为38.8（28.4 - 60.5），然而这些在统计学上无差异。
结论
对于伴有软组织损伤的闭合性和开放性不稳定踝关节骨折，腓骨钉是一种有效的治疗选择。
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