不同内固定方式对后踝骨折固定的生物力学效果及临床疗效分析

目的：比较不同内固定方式对后踝关节骨折固定的生物力学效果及临床疗效。方法：选择2009年1月-2010年12月来我院就诊经X线检查确诊的后踝骨折患者28例为研究对象，根据所使用内固定方法不同，分为拉力螺钉组和微型钢板组，随访比较两组的手术时间、出血量、固定成功率、住院时间、后遗症及生物力学效果。结果：所有患者均随访至拆除内固定，拉力螺钉组和微型钢板组随访时间（t=-2．102）进行比较，P〉0．05两组差异无统计学意义。两组手术时间（t=4．293）、手术出血量（t=6．827）、固定成功率（2=，5．568）和住院时间（t=3．903）比较，P均〈0．05，差异有统计学意义。当骨折块波及胫骨远端关节面s25％和其〉25％时，两组内固定失效临界压力比较，P〈均0．05，两组内固定压力差异无统计学意义。结论：由于后踝关节的特殊结构和复杂的力学特点，拉力螺钉内固定在治疗效果优于微型钢板内固定法，但当骨折块波及胫骨远端关节面〉25％生物力学效果微型钢板内固定法更佳，因此根据患者个体骨折差异选择合适的内固定方法。

Compare of the Repair Effects and Biomechanices for Different Ways of Internal Fixation for Ankle Joint

Objective： To compare the repair effects and biomechanics for different ways of internal fixation for ankle joint, in order to provide basis for clinical trealment. Methods： A retrospective analysis of 28 posterior malleolus fracture models were inducted, in which all patients were divided into 2 groups by the way of internal fixation from Jan. 2009 to Dec. 2012 in our hospital. To compare the time of follow-up, blood loss, the critical pressures of ineffective internal fixation, the surgery time, the successful rate of internal fixation, hospital stay and the average pressures of ineffective internal fixation after follow-up. Results： The time of follow-up （t=0.833, P：〉0.05） and blood loss （t=0.938, P〉0.05） were not statistical different significantly. The surgery time（t=4.293, P〈0.05）, the successful rate of internal fixation （ 2=,5.568, P〈0.05）and hospital stay（t=-3.903, P〈0.05）the average pressures of ineffective internal fixation （t=3. 891, P 〉0.05）for two groups were statistical different significantly. The pressures of two groups were statistical different significantly when the posterior articular facet cover was less than 25% （ t=4.012, P〈0.05） or more than 25% （t=-3.891, P〈0.05）. Conclusion： The effects of inferior iliac spine was better than Locked-plate fracture-fixation when the posterior articular facet cover was less than 25%, and the effects of Locked-plate fracture-fixationwas better than inferior iliac spine when the posterior articular facet cover was more than 25% Different treatment was given according to the type of the individual difference.