Objective: To investigate the effectiveness of spring hook plate for posterior malleolus fracture by comparing with cannulated screw.
Methods: Between March 2012 and September 2013, 100 cases of posterior malleolus fracture were treated. Fracture was fixed with spring hook plate in 50 cases (research group) or with cannulated screw in 50 cases (control group). There was no significant difference in gender, age, cause of injury, associated injury, and injury to operation time between 2 groups P>0.05). The operation time, intraoperative blood loss, union time of fracture, ankle range of motion (ROM), and complications were recorded and compared. The ankle joint function was evaluated by the ankle hindfoot scale of American Orthopedic Foot and Ankle Society (AOFAS).
Results: There was no significant difference in operation time and intraoperative blood loss between 2 groups P>0.05). The patients were followed up 6-12 months (mean, 9.8 months) in the control group and 6-12 months (mean, 9.2 months) in the research group. The X-ray films showed that fracture union was achieved in 2 groups; the union time of the research group[(9.5±1.4) weeks] was significantly shorter than that of the control group[(10.5±1.3) weeks] (t=2.029, P=0.017). The ROM was (25.1±3.2)° for dorsal extension and was (45.3±2.3)° for plantar flexion in the research group at 6 months after operation, which were significantly better than those of the control group[(22.2±2.3)° and (41.2±2.5)°] (t=-3.950, P=0.001; t=-5.212, P=0.000). The ankle hindfoot scale of AOFAS was 85.1±8.6 in the control group at 6 months; the results were excellent in 15 cases, good in 20 cases, and moderate in 15 cases with an excellent and good rate of 70%. The ankle hindfoot scale of AOFAS was 89.4±7.9 in the research group; the results were excellent in 20 cases, good in 22 cases, and moderate in 8 cases with an excellent and good rate of 84%; there was significant difference between 2 groups (t=-2.191, P=0.042; χ2=0.413, P=0.018). Incision infection occurred in 3 cases of the control group and in 2 cases of the research group, which was cured after dressing change; screw loosening and fracture displacement occurred in 3 and 4 cases of the control group, but did not in the research group. The complication rate of the control group and the research group was 20% and 4% respectively, showing significant difference between 2 groups (χ2=6.061, P=0.028).
Conclusions: Spring hook plate can shorten the time of union, increase the ROM of the ankle after operation, get good functional restoration, and decrease the rate of complication compared with cannulated screw fixation.
目的: 通过与空心钉固定比较，探讨弹簧钩板治疗后踝骨折的临床疗效。.
方法: 2012年3月-2013年9月，共100例后踝骨折患者符合选择标准纳入研究。根据入院顺序将患者分为对照组（50例，采用空心钉固定）和研究组（50例，采用弹簧钩板固定）。两组患者性别、年龄、致伤原因、合并伤及受伤至手术时间等一般资料比较差异均无统计学意义（P＞0.05），具有可比性。记录并比较两组患者手术时间、术中出血量、骨折愈合时间及踝关节活动度，观察并发症发生情况；采用美国矫形足踝协会（AOFAS）踝与后足功能评分评价踝关节功能。.
结果: 两组手术时间和术中出血量比较差异均无统计学意义（P＞0.05）。两组患者均获随访，对照组随访时间6～12个月，平均9.8个月；研究组6～12个月，平均9.2个月。X线片复查示两组骨折均愈合，研究组骨折愈合时间为（9.5±1.4）周，显著优于对照组的（10.5±1.3）周（t=2.029，P=0.017）。术后6个月研究组踝关节背伸和跖屈活动度分别为（25.1±3.2）、（45.3±2.3）°，均显著优于对照组的（22.2±2.3）、（41.2±2.5）°（t=-3.950，P=0.001；t=-5.212，P=0.000）。术后6个月对照组AOFAS踝与后足功能评分为（85.1±8.6）分，获优15例、良20例、中15例，优良率70%；研究组评分为（89.4±7.9）分，获优20例、良22例、中8例，优良率84%；两组比较差异均有统计学意义（t=-2.191，P=0.042；χ2=0.413，P=0.018）。并发症：对照组发生切口感染3例，研究组2例，均经换药后愈合；对照组术后发生空心钉退钉3例、后踝移位4例，研究组均无退钉及后踝移位发生。对照组和研究组并发症发生率分别为20%和4%，比较差异有统计学意义（χ2=6.061，P=0.028）。.
结论: 与空心钉固定比较，弹簧钩板治疗后踝骨折能缩短骨折愈合时间，增加术后踝关节活动范围，获得更好的功能恢复以及可降低并发症发生几率。.
Keywords: Cannulated screw; Internal fixation; Posterior malleolus fracture; Spring hook plate.