腓骨髓内固定与腓骨髓外固定在踝关节骨折手术早期疗效上无差异

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2024-10-18 DOI:10.1016/j.injury.2024.111973

Kyle Auger, Ian S. Hong, McKenzie A. Mayer, Pasquale Gencarelli Jr., Conner J. Robbins, Jaclyn M. Jankowski, Frank A. Liporace, Richard S. Yoon

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引用次数: 0

摘要

导读：本研究旨在比较微创髓内固定（IMF）与钢板固定（PF）治疗腓骨远端骨折的术后并发症和疗效。材料和方法回顾性审查了2017年8月至2022年9月期间在一家三级医疗中心接受手术治疗且临床随访至少6个月的所有年龄≥18岁的连续踝关节骨折患者。患者被分为接受髓内固定和髓外腓骨固定的两组。主要结果包括相关人口统计学因素（糖尿病、骨质疏松症、查尔森合并症指数[CCI]）、手术时间、并发症发生率、再次手术率。次要结果包括明确骨折固定的时间、骨折特征（AO/OTA 和 Lauge-Hansen 分级）、需要固定的联合韧带不稳定性和出院处置。在 IMF 组中，25 名患者接受了 IM 钉固定，16 名患者接受了经皮螺钉固定。更多的 IMF 患者患有糖尿病（39% 对 22%，P < 0.001）、骨质疏松症（22% 对 3%，P < 0.001）和中度或重度 CCI（41% 对 23%，P = 0.017）。使用 IMF 技术时，手术时间明显缩短（80.4 ± 43.1 分钟 vs 99.1 ± 43.1 分钟，p = 0.012）。各组之间的总体并发症发生率或并发症发生时间无明显差异（分别为 p = 0.578 和 p = 0.082）；但如果进行细分，IMF 患者与 PF 患者相比，伤口相关并发症发生率呈下降趋势（5% vs 9%，p = 0.291）。没有 IMF 患者出现深部或表皮感染，只有 2 例（5%）患者出现伤口开裂。再手术率（15% vs 10%，p = 0.267）和骨折愈合时间（2.7 ± 2.2 个月 vs 3.1 ± 2.0 个月，p = 0.301）没有显著差异。最终随访时（IMF：15.0 ± 12.2 个月 vs PF：28.5 ± 19.5 个月），IMF 的 Olerud 和 Molander 踝关节评分明显高于 PF（87.1 ± 14.2 vs 76.2 ± 22.6，p = 0.002）。值得注意的是，虽然我们预计 PF 组的伤口问题发生率较高，但感染率并无明显差异。无论是IMF还是PF，其固定效果和预后都是可靠的，因此，如果采用适当的软组织、生物友好型技术，IMF或PF都是固定腓骨骨折的可靠选择。

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No difference in early outcomes comparing intramedullary versus extramedullary fibular fixation in operative ankle fractures

Introduction

The purpose of this study was to compare postoperative complications and outcomes of minimally invasive intramedullary fixation (IMF) versus plate fixation (PF) in the treatment of distal fibular fractures.

Materials and methods

A retrospective review was performed from identifying all consecutive ankle fracture patients aged ≥18-years-old surgically managed between August 2017 to September 2022 at a tertiary care center with minimum 6 months clinical follow-up. Patients were grouped into those receiving intramedullary versus extramedullary fibular fixation. The primary outcomes were relevant demographic factors (diabetes, osteoporosis, charlson comorbidity index [CCI]), surgical time, complication rates, reoperation rates. Secondary outcomes included time to definitive fracture fixation, fracture characteristics (AO/OTA and Lauge-Hansen classification), syndesmotic instability requiring fixation and discharge disposition.

Results

Forty-one IMF patients (average age 55.3 ± 18.1yrs) and 162 PF patients (47.7 ± 17.4yrs) were identified and included in this study. Within the IMF group, 25 patients received IM nailing and 16 patients received percutaneous screw fixation. A greater proportion of IMF patients had diabetes (39 % vs 22 %, p < 0.001), osteoporosis (22 % vs 3 %, p < 0.001), and moderate or severe CCI (41 % vs 23 %, p = 0.017). Surgical time was significantly reduced when using IMF technique (80.4 ± 43.1 min vs 99.1 ± 43.1 min, p = 0.012). Overall complication rates or time to complication did not differ significantly between groups (p = 0.578 and p = 0.082, respectively); however, when sub-stratified, IMF patients trended towards experiencing fewer wound related complications versus PF patients (5 % vs 9 %, p = 0.291). No IMF patients experienced deep or superficial infections and only 2 (5 %) patients experienced wound dehiscence. Reoperation rates(15 % vs 10 %, p = 0.267) and time to fracture union (2.7 ± 2.2 mos vs 3.1 ± 2.0 mos, p = 0.301) did not differ significantly. At final follow-up (IMF: 15.0 ± 12.2 mos vs PF: 28.5 ± 19.5 mos), Olerud and Molander ankle score was significantly higher in IMF compared to PF (87.1 ± 14.2 vs 76.2 ± 22.6, p = 0.002).

Conclusion

Patients in the IMF group at baseline had several comorbid medical conditions that put them at high risk for wound related complications, however, postoperatively they demonstrated higher functional scores and similar complication rates compared to the PF group. It is important to note, however, while we expected a higher rate of wound issues with the PF group, there were no significant differences in infection rates. Either IMF and PF is reliable for fixation and outcomes, and thus with proper soft tissue, biologically friendly technique, either IMF or PF is a reliable choice in the fixation of fibula fractures.

Level of evidence

III, retrospective cohort comparison study.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.