Objective: To investigate the effectiveness of a new hook-shaped anatomical locking plate in the treatment of Danis-Weber type A lateral malleolus fractures.
Methods: A retrospective analysis was performed on the clinical data of 45 patients with Danis-Weber type A lateral malleolus fractures who met the selection criteria between November 2020 and November 2022. According to the surgical methods, they were divided into the observation group (treated with the new hook-shaped anatomical locking plate, 23 cases) and the control group (treated with the conventional lateral malleolus anatomical locking plate, 22 cases). There was no significant difference in baseline data such as gender, age, cause of injury, Danis-Weber type of fracture, time from injury to operation, and combined ligament injury between the two groups ( P>0.05). The operation time, partial weight-bearing time, return to work time, and postoperative complications were recorded and compared between the two groups. The function and pain of ankle joint were evaluated by the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and visual analogue scale (VAS) score at 1 and 3 months after operation, and at last follow-up, and the American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 months after operation and at last follow-up.
Results: All patients were followed up 10-18 months (mean, 15.1 months). There was no significant difference in operation time between the two groups ( P>0.05); the postoperative partial weight-bearing time and return to work time of the observation group were significantly earlier than those of the control group ( P<0.05). During the follow-up, there was 1 case of joint stiffness in the observation group, and 1 case of joint surface displacement, 1 case of joint stiffness, and 1 case of traumatic arthritis in the control group. There was no significant difference in the incidences of complications between the two groups ( P>0.05). With the extension of time after operation, the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and VAS score of the two groups gradually improved, and there were significant differences between different time points ( P<0.05); At 1 and 3 months after operation, the above indexes in the observation group were significantly better than those in the control group ( P<0.05), and there was no significant difference between the two groups at last follow-up ( P>0.05). The difference of AOFAS score between the last follow-up and 3 months after operation in the observation group was significantly better than that in the control group ( P<0.05).
Conclusion: Compared with the conventional lateral malleolus anatomical locking plate, the new hook-shaped anatomical locking plate has a more reliable fixation effect in the treatment of Danis-Weber type A lateral malleolus fracture, which is conducive to early functional exercise of the ankle joint, so that patients can bear weight earlier and return to work earlier, and the operation time is not significantly prolonged, and the effectiveness is satisfactory.
目的: 探讨新型钩匙状解剖锁定板治疗 Danis-Weber A 型外踝骨折的临床疗效。.
方法: 回顾分析2020年11月—2022年11月收治且符合选择标准的45例Danis-Weber A 型外踝骨折患者临床资料。依据手术方式分为观察组（采用新型钩匙状解剖锁定板治疗，23例）和对照组（采用常规外踝解剖锁定钢板治疗，22例）。两组患者性别、年龄、致伤原因、骨折Danis-Weber分型、受伤至手术时间及合并韧带损伤等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术后部分负重时间、返回工作时间和术后并发症发生情况。采用术后1、3个月及末次随访时踝关节背伸、跖屈、内翻、外翻活动度及疼痛视觉模拟评分（VAS），术后3个月及末次随访时美国矫形足踝协会（AOFAS）评分，对患者踝关节功能及疼痛情况进行评估。.
结果: 两组患者均获随访，随访时间10～18个月，平均15.1个月。两组手术时间差异无统计学意义（ P>0.05）；观察组术后部分负重时间和返回工作时间均早于对照组（ P<0.05）。随访期间，观察组出现1例关节僵硬，对照组出现1例关节面移位、1例关节僵硬和1例创伤性关节炎；两组各并发症发生率比较差异均无统计学意义（ P>0.05）。随术后时间延长，两组患者踝关节跖屈、背伸、内翻、外翻活动度和VAS评分均逐渐改善，各时间点间差异均有统计学意义（ P<0.05）；术后1、3个月，观察组上述指标均显著优于对照组（ P<0.05），末次随访时两组间各指标比较差异均无统计学意义（ P>0.05）。末次随访与术后3个月的AOFAS评分差值观察组优于对照组（ P<0.05）。.
结论: 与常规外踝解剖锁定钢板相比，采用新型钩匙状解剖锁定板固定治疗Danis-Weber A型外踝骨折更牢靠，有利于踝关节早期功能锻炼，使患者更早负重，尽早返回工作岗位，且手术时间无显著延长，临床效果满意。.
Keywords: Lateral malleolus fracture; ankle joint; internal fixation; lateral malleolus anatomical locking plate; new hook-shaped anatomical locking plate.