CAJ | 학술논문

目的：分析石膏外固定联合早期功能康复锻炼对老年三踝骨折患者术后关节功能的影响。方法选择2008年~2012年新疆阿拉尔市人民医院骨科诊断为三踝骨折42例，入组患者年龄≥60岁。所有患者均采用外踝解剖钢板，内踝及后踝采用上肢空心钉固定的方式行关节内固定术，如合并有内外侧韧带损伤者给予行修补术，术后给予石膏外固定术。患者术后24 h摄片术后关节恢复解剖关系，对位、对线良好。术后入组患者按随机数字表法分为研究组与对照组各21例。对照组术后2周开始采用踝关节常规康复锻炼。研究组患者术后由康复小组指导开始规范踝关节康复训练。术后3个月，比较2组患者踝穴形态变化及采用AOFAS踝关节评分比较2组患者踝关节功能差异。随访24个月，统计2组患者创伤性踝关节炎发生率。结果康复前，2组患者踝穴横径、纵径、高度、冠状位角度差值、矢状位角度差值差别无统计学意义（P＞0.05）。康复后，研究组与对照组踝穴横径[（0.54±0.23）比（0.89±0.27）mm，t=3.041]、纵径[（0.76±0.34）比（1.03±0.49）mm，t=2.985]、高度[（0.13±0.04）比（0.24±0.05）mm，t=2.873]、冠状位角度差值[（1.68±0.51）比（2.46±0.63），t=3.052]、矢状位角度差值[（1.03±0.23）比（1.79±0.45），t=3.164]明显减少，2组差别有统计学意义（P＜0.05）。术后3个月，研究组与对照组踝关节功能评分优良率[（93.94%）比（81.54%），χ2=3.149]明显升高。随访24个月，研究组与对照组创伤性关节炎发生率[（13.79%）比（35.71%），χ2=3.461]明显降低，2组比较差异有统计学意义（P＜0.05）。结论石膏外固定联合早期功能康复锻炼能明显提高老年三踝骨折患者术后关节功能的康复，提高踝关节功能评分，减少创伤性关节炎的发生。
목적：분석석고외고정연합조기공능강복단련대노년삼과골절환자술후관절공능적영향。방법선택2008년~2012년신강아랍이시인민의원골과진단위삼과골절42례，입조환자년령≥60세。소유환자균채용외과해부강판，내과급후과채용상지공심정고정적방식행관절내고정술，여합병유내외측인대손상자급여행수보술，술후급여석고외고정술。환자술후24 h섭편술후관절회복해부관계，대위、대선량호。술후입조환자안수궤수자표법분위연구조여대조조각21례。대조조술후2주개시채용과관절상규강복단련。연구조환자술후유강복소조지도개시규범과관절강복훈련。술후3개월，비교2조환자과혈형태변화급채용AOFAS과관절평분비교2조환자과관절공능차이。수방24개월，통계2조환자창상성과관절염발생솔。결과강복전，2조환자과혈횡경、종경、고도、관상위각도차치、시상위각도차치차별무통계학의의（P＞0.05）。강복후，연구조여대조조과혈횡경[（0.54±0.23）비（0.89±0.27）mm，t=3.041]、종경[（0.76±0.34）비（1.03±0.49）mm，t=2.985]、고도[（0.13±0.04）비（0.24±0.05）mm，t=2.873]、관상위각도차치[（1.68±0.51）비（2.46±0.63），t=3.052]、시상위각도차치[（1.03±0.23）비（1.79±0.45），t=3.164]명현감소，2조차별유통계학의의（P＜0.05）。술후3개월，연구조여대조조과관절공능평분우량솔[（93.94%）비（81.54%），χ2=3.149]명현승고。수방24개월，연구조여대조조창상성관절염발생솔[（13.79%）비（35.71%），χ2=3.461]명현강저，2조비교차이유통계학의의（P＜0.05）。결론석고외고정연합조기공능강복단련능명현제고노년삼과골절환자술후관절공능적강복，제고과관절공능평분，감소창상성관절염적발생。
Objective To analyze the inlfuence of joint function with plaster external ifxation combined with early functional exercise on postoperative rehabilitation of three ankle fracture in elderly patients. Methods All 42 cases patients with three ankle fracture coming form the department of orthopedics of Alar People’s Hospital of Xinjiang city from 2008 to 2012 randomly were divided into the study group and control group with 21 cases in each group .The patients in the control group were given conventional rehabilitation exercise of ankle joint from the second week after operation, while the rehabilitation guidance group began to keep ankle joint function training in the study group. The indexes of ankle morphology changes and ankle joint function score were compared between the two groups when three months after surgery. After 24 months of follow-up, the incidence of traumatic ankle arthritis was compared between the two groups. Results Before rehabilitation, the indexes of ankle diameter, longitudinal diameter, height, coronal and sagittal angle difference have no signiifcant atatistical difference. After recovery, there were some comparison on the indexes of ankle diameter[(0.54±0.23)vs.(0.89±0.27)mm, t=3.041], longitudinal diameter[(0.76±0.34)vs.(1.03± 0.49)mm, t=2.985], height[(0.13±0.04)vs.(0.24±0.05)mm, t=2.873], coronal angle difference[(1.68±0.51)vs.(2.46±0.63), t=3.052] and sagittal angle difference[(1.03± 0.23)vs.(1.79±0.45), t=3.041]between the study group and control group. The indexes in study group were decreased signiifcantly more than the control group. After three months of postoperation, the excellent and good rate of ankle function score in study group was 93.94%, while that was 81.54%in control group. Following up 24 months, the incidence of traumatic arthritis was 13.79%in study group and 35.71%in control group, there was signiifcant statistical difference between two groups. Conclusion Plaster external ifxation combined with early function rehabilitation exercise can signiifcantly improve the ankle joint function of postoperative rehabilitation in the elderly patients with three ankle fracture, improve the ankle joint function score, reduce the occurrence of traumatic arthritis.