踝关节骨折脱位手术治疗后的长期临床和影像学结果:放射学结果不佳总是重要的吗?

IF 0.5 4区 医学 Q4 ORTHOPEDICS
Tuna Pehlivanoglu, Mehmet Demirel, Daghan Koyuncu, Natiq Valiyev, Turgut Akgül, Onder Ismet Kilicoglu
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引用次数: 0

摘要

背景 在临床实践中,踝关节骨折占所有创伤性骨折的 10%。并发胫骨脱位占所有踝关节骨折的 21-36%。虽然损伤机制与非脱位性踝关节骨折相似,但骨折脱位会造成更广泛的骨骼和软组织损伤。由于同时伴有病理变化,治疗对骨科医生来说是一项挑战。踝关节骨折脱位与畸形、慢性疼痛以及最重要的创伤后骨关节炎有关。我们旨在研究踝关节骨关节炎放射学分期与临床结果之间的关系。方法 研究纳入了 27 名患者(17 名女性,10 名男性)。对记录和数据进行了回顾性分析。最后随访时的临床状况由一名骨科医生进行评估。活动范围(ROM)、美国足踝矫形协会(AOFAS)踝-后足评分、视觉模拟量表(VAS)是评估的临床参数。放射学评估是通过标准的前后位(AP)、侧位和榫眼视图进行的。对术前骨韧带损伤模式、后踝骨骨折、巩膜损伤和术后踝关节骨性关节炎进行了调查。结果 在接受评估的 27 名患者中,最终随访的 AOFAS 平均值为 85 ± 8.12,日常活动的 VAS 平均值为 1.52 ± 0.70。患侧踝关节背屈和跖屈的平均值(分别为 14.07 ± 7.97°和 36.30 ± 6.59°)明显低于非患侧(分别为 28.15 ± 2.82°和 46.30 ± 2.97°)(P < 0.001)。内翻和外翻无明显差异。24 名患者出现了踝关节骨关节炎的影像学症状,3 名患者仍未出现骨关节炎症状。高仓分期在任何变量上都没有发现明显差异。结论 结果表明,虽然踝关节骨折脱位患者的创伤后骨关节炎发生率较高,但手术治疗取得了良好的功能效果。即使根据高仓分型出现了晚期踝关节炎,患者的临床和功能效果也令人满意。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Background Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21-36% of all ankle fractures. Although mechanism of injury is similar to non-dislocated ankle fractures, fracture-dislocations cause more extensive bone and soft tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain and most importantly, posttraumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes. Methods 27 patients (17 female, 10 male) were included in the study. Records and data were retrospectively analyzed. Clinical status at the final follow-up was evaluated by a single orthopedic surgeon. Range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) were the clinical parameters that were assessed. Radiological assessment was made by standard anteroposterior [AP], lateral, and mortise views. Pre-operative osseo-ligamentous injury pattern, presence of posterior malleolar fracture, syndesmosis injury and post-operative ankle osteoarthritis were investigated. Results For 27 patients that were evaluated, at the final follow-up, mean AOFAS was 85 ± 8.12, and mean VAS during daily activities was 1.52 ± 0.70. Mean ankle dorsiflexion and plantar flexion were significantly lower on the affected sides (14.07 ± 7.97° and 36.30 ± 6.59°) than on the unaffected sides (28.15 ± 2.82° and 46.30 ± 2.97°), respectively (p < 0.001). No significant difference for inversion and eversion was observed. Twenty-four patients demonstrated radiographic signs of ankle osteoarthritis, and three remained without evidence of osteoarthritis. No significant difference was found among Takakura's stages in any of the variables. Conclusion The results illustrated that although post-traumatic osteoarthritis rate was high for ankle fracture-dislocation patients, surgical treatment achieved excellent functional results. Even if advanced stages of ankle arthritis according to Takakura's classification developed, patients had satisfactory clinical and functional results.

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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
128
审稿时长
6-12 weeks
期刊介绍: The Journal of the American Podiatric Medical Association, the official journal of the Association, is the oldest and most frequently cited peer-reviewed journal in the profession of foot and ankle medicine. Founded in 1907 and appearing 6 times per year, it publishes research studies, case reports, literature reviews, special communications, clinical correspondence, letters to the editor, book reviews, and various other types of submissions. The Journal is included in major indexing and abstracting services for biomedical literature.
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