微创治疗后踝骨骨折的临床观察

目的：对微创治疗后踝骨骨折的临床疗效进行观察,并对其安全性进行探讨。方法：选取从2010年2月-2013年2月收治的60位踝骨骨折的患者,将患者分成A组与B组,全部患者在进行手术以前都对踝关节螺旋进行常规的CT检查,并对后踝骨折移位的状况、骨折块的大小、踝关节的水平线与横断面的主骨折的角度进行了解。在A组患者的手术过程中,首先要对内踝和外踝进行复位与固定,按照手术以前CT检查的具体情况对手术过程中导针的方向和位置进行选择,后裸骨折经皮微创空心钉进行固定。B组患者采取改良以后的内外踝切口,再将内外踝切口显露的同时固定和显露后裸。对患者进行6~20个月的随访,根据AOFAS的评分标准进行评分。结果：B组患者中,优13例（43%）,良6例（20%）,可6例（20%）,差5例（17%）;A组患者中,优17例（57%）,良10例（33%）,可2例（7%）,差1例（3%）,A组的优良率明显高于B组,差异有统计学意义（P〈0.05）。A组患者的感染与创伤性神经情况明显优于B组,比较差异均有统计学意义（P〈0.05）;而两组创伤性关节炎与畸形愈合的情况比较差异无统计学意义（P〉0.05）;两组均无骨折不愈合以及断钉的情况发生。结论：采取经皮微创空心钉内固定的方式,安全性高,造成的创伤也比较小,同时也能减少感染的情况发生,不会影响其稳定性,是比较安全的手术治疗方式,具有临床推广价值。

Minimally Invasive Treatment of Ankle Fractures Observation

Objective： To observe the clinical curative effects of minimally invasive treatment of ankle fracture and discuss its security.Method： 60 patients with ankle fractures who were treated in our hospital from February 2010 to February 2013, the patients were divided into group A and group B, all the patients were treated conventional ankle spiral CT examination before surger, and the posterior malleolar fracture displacement, fracture of ankle block size, the horizontal line and the cross section the main fracture were realized.In the operation process in the group A, the medial malleolus and lateral malleolus were reset and fixed firstly, according to the specific situation of CT examination before operation, the direction and position of needle were selected in the operation process, bare fracture after percutaneous cannulated screw were fixed.The patients of group B were improved after the malIeolus incision, then the external ankle after incision in fixed and at the same time show naked.The patients were 6 months to 20 months of follow- up, were scored according to the AOFAS criteria.Result： Patients in the B group, excellent in 13 cases （ 43% ）, good in 6 cases （ 20% ）, fair in 6 cases （ 20% ）, poor in 5 cases （ 17% ） ; In group A, excellent in 17 cases （ 57% ）, good in 10 cases （ 33% ）, fair in 2 cases （ 7% ）, poor in 1 case （ 3% ）, the excellent and good rate of group A was significantly higher than that in group B, the difference was statistically significant （ P〈0.05 ） .The infection in patients with traumatic nerve of Group A was better than that of B group, there was statistically significant difference （ P〈0.05 ） ; the two groups of patients with traumatic arthritis and malunion were compared, there was no statistical significance （ P〉0.05 ） ; the patients of two groups had no nonunion of fracture and broken nails situation.Conelusion： Take the way of minimally invasive peroutaneous hollow screw internal fixation, highsafety, traamais relatively small, but also can reduce the incidence of infection, does not affect its stability, is the way of operation treatment is safe, has clinical value.