Tanoğlu Oğuzhan, Gökgöz Mehmet Burak, Özmeriç Ahmet, Alemdaroğlu Kadir Bahadır
Specialist in Orthopedics, Department of Orthopedics and Traumatology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey.
Resident Doctor in Orthopedics, Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Research and Training Hospital, Ankara, Turkey.
J Foot Ankle Surg. 2019 Jul;58(4):702-705. doi: 10.1053/j.jfas.2018.11.033. Epub 2019 May 10.
Soft tissue injuries associated with malleolar fracture-dislocations may increase postoperative rates of wound complication. Ankle-spanning frame plays a fundamental role in the local damage control orthopedics while gaining time for definitive surgery. The objective of this study was to evaluate the effect of a 2-stage surgery for the unstable malleolar fracture-dislocations with severe soft tissue injuries compared to a 1-stage surgery in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and Olerud-Molander ankle scores (OMAS). We analyzed 45 patients who met our study criteria. The patients were divided into 2 groups according to staged surgeries. Demographic data of patients, comorbidities, alcohol and tobacco use, Tscherne soft tissue injury scores, the AOFAS hindfoot-ankle and OMAS, postoperative complications, total hospitalization times, waiting time between stages, and waiting time from admission to surgery times were investigated. There was a statistically significant difference between the groups in terms of the mean total hospitalization times (p = .007), waiting time from admission to surgery (p < .001), gender (p = .005), and Tscherne soft tissue injury scores (p < .001). The mean AOFAS hindfoot-ankle and OMAS of the groups did not differ statistically at a minimum of 12 months of the follow-up period (p = .094 and p = .126, respectively). A 2-stage surgery can be performed safely in the carefully selected patients with the unstable malleolar fracture-dislocations with Tscherne grades 2 and 3 soft tissue injuries, and this surgery does not affect the postoperative AOFAS hindfoot-ankle and OMAS statistically compared to a 1-stage surgery at a minimum of 12 months of the follow-up period.
与踝关节骨折脱位相关的软组织损伤可能会增加术后伤口并发症的发生率。跨踝关节外固定架在局部损伤控制骨科中起着重要作用，同时为确定性手术争取时间。本研究的目的是比较两阶段手术与一阶段手术治疗伴有严重软组织损伤的不稳定踝关节骨折脱位的效果，评估指标为美国矫形足踝协会（AOFAS）后足-踝关节评分和奥勒鲁德-莫兰德踝关节评分（OMAS）。我们分析了45例符合研究标准的患者。根据分期手术将患者分为两组。对患者的人口统计学数据、合并症、烟酒使用情况、切尔内软组织损伤评分、AOFAS后足-踝关节评分和OMAS、术后并发症、总住院时间、阶段间等待时间以及入院至手术的等待时间进行了调查。两组在平均总住院时间（p = 0.007）、入院至手术的等待时间（p < 0.001）、性别（p = 0.005）和切尔内软组织损伤评分（p < 0.001）方面存在统计学显著差异。在至少12个月的随访期内，两组的平均AOFAS后足-踝关节评分和OMAS在统计学上无差异（分别为p = 0.094和p = 0.126）。对于精心挑选的伴有切尔内2级和3级软组织损伤的不稳定踝关节骨折脱位患者，可以安全地进行两阶段手术，并且与一阶段手术相比，在至少12个月的随访期内，该手术在统计学上不影响术后AOFAS后足-踝关节评分和OMAS。
