临时外固定架固定是治疗踝关节骨折脱位的安全替代方法，而后踝骨块大小预测复位丢失：病例对照研究。
Temporizing cast immobilization is a safe alternative to external fixation in ankle fracture-dislocation while posterior malleolar fragment size predicts loss of reduction: a case control study.
机构信息
Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
出版信息
BMC Musculoskelet Disord. 2022 Jul 22;23(1):698. doi: 10.1186/s12891-022-05646-6.
BACKGROUND
To determine if temporizing cast immobilization is a safe alternative to external fixator (ex-fix) in ankle fracture-dislocations with delayed surgery or moderate soft-tissue injury, we analysed the early complications and re-dislocation rates of cast immobilization in relation to ex-fix in patients sustaining these injuries.
METHODS
All skeletally mature patients with a closed ankle fracture-dislocation and a minimum 6-months follow-up treated between 2007 and 2017 were included. Baseline demographics, comorbidities, injury description, treatment history and complications were assessed.
RESULTS
In 160 patients (94 female; mean age 50 years) with 162 ankle fracture-dislocations, 35 underwent primary ex-fix and 127 temporizing cast immobilizations. Loss of reduction (LOR) was observed in 25 cases (19.7%) and 19 (15.0%) were converted to ex-fix. The rate of surgical site infections (ex-fix: 11.1% vs cast: 4.6%) and skin necrosis (ex-fix: 7.4% vs cast: 6.5%) did not differ significantly between groups (p = 0.122 and p = 0.825). Temporizing cast immobilization led to an on average 2.7 days earlier definite surgery and 5.0 days shorter hospitalization when compared to ex-fix (p < 0.001). Posterior malleolus fragment (PMF) size predicted LOR with ≥ 22.5% being the threshold for critical PMF-size (p < 0.001).
CONCLUSION
Temporizing cast immobilization was a safe option for those ankle fracture-dislocations in which immediate definite treatment was not possible. Those temporized in a cast underwent definite fixation earlier than those with a fix-ex and had a complication rate no worse than the ex-fix patients. PMF-size was an important predictor for LOR. Primary ex-fix seems appropriate for those with ≥ 22.5% PMF-size.
TRIAL REGISTRATION
The study does not meet the criteria of a prospective, clinical trial. There was no registration.
背景
为了确定在踝关节骨折脱位延迟手术或中度软组织损伤的情况下，临时石膏固定是否是外固定架（ex-fix）的安全替代方法，我们分析了这些损伤患者中石膏固定与 ex-fix 相关的早期并发症和再脱位率。
方法
纳入了 2007 年至 2017 年间接受治疗的所有闭合性踝关节骨折脱位且随访至少 6 个月的骨骼成熟患者。评估了基线人口统计学、合并症、损伤描述、治疗史和并发症。
结果
在 160 例（94 例女性；平均年龄 50 岁）162 例踝关节骨折脱位患者中，35 例行初次 ex-fix，127 例行临时石膏固定。25 例（19.7%）发生复位丢失（LOR），19 例（15.0%）转为 ex-fix。手术部位感染（ex-fix：11.1% vs 石膏：4.6%）和皮肤坏死（ex-fix：7.4% vs 石膏：6.5%）的发生率在两组间无显著差异（p=0.122 和 p=0.825）。与 ex-fix 相比，临时石膏固定可使确定性手术平均提前 2.7 天，住院时间缩短 5.0 天（p<0.001）。后踝骨碎片（PMF）大小预测 LOR，≥22.5%为临界 PMF 大小阈值（p<0.001）。
结论
对于那些无法立即进行确定性治疗的踝关节骨折脱位，临时石膏固定是一种安全的选择。那些用石膏固定的患者比用 ex-fix 固定的患者更早地进行确定性固定，且并发症发生率并不比 ex-fix 患者差。PMF 大小是 LOR 的一个重要预测因素。对于 PMF 大小≥22.5%的患者，初次 ex-fix 似乎是合适的。
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