Stake Ingrid K, Ræder Benedikte W, Gregersen Martin G, Molund Marius, Wang Johan, Madsen Jan E, Husebye Elisabeth E
Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Bone Joint J. 2023 Jan;105-B(1):72-81. doi: 10.1302/0301-620X.105B1.BJJ-2022-0595.R1.
The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients.
In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis.
At 24 months, the median AOFAS score was equivalent in the two groups (nail 90 (interquartile range (IQR) 82 to 100), plate 95 (IQR 87 to 100), p = 0.478). There were statistically more complications and secondary operations after nail than plate fixation (p = 0.024 and p = 0.028, respectively). There were no other significant differences in the outcomes between the two groups.
The functional outcome after nail and plate fixation was equivalent; however, the complication rate and number of secondary operations was significantly higher after nail fixation. These results suggest that plate fixation should usually be the treatment of choice for unstable ankle fractures in the elderly.Cite this article: 2023;105-B(1):72-81.
本研究旨在比较老年患者踝关节不稳定骨折采用髓内钉和钢板固定后的功能及影像学结果以及并发症发生率。
在这项多中心研究中，120例年龄≥60岁的急性踝关节AO/OTA 44-B型不稳定骨折患者被随机分为髓内钉固定组或钢板固定组，并在术后随访24个月。主要结局指标是美国矫形足踝协会（AOFAS）踝-后足评分。次要结局指标包括曼彻斯特-牛津足部问卷、奥勒鲁德和莫兰德踝关节评分、欧洲五维健康量表、疼痛视觉模拟评分、并发症、骨折复位质量、骨不连以及骨关节炎的发生情况。
在24个月时，两组的AOFAS评分中位数相当（髓内钉组90分（四分位间距（IQR）82至100），钢板组95分（IQR 87至100），p = 0.478）。与钢板固定相比，髓内钉固定后出现并发症和二次手术的情况在统计学上更多（分别为p = 0.024和p = 0.028）。两组在其他结局方面无显著差异。
髓内钉和钢板固定后的功能结局相当；然而，髓内钉固定后的并发症发生率和二次手术次数显著更高。这些结果表明，对于老年踝关节不稳定骨折，钢板固定通常应作为首选治疗方法。引用本文：2023;105-B(1):72-81。
