可吸收螺钉治疗后踝骨折的早期临床疗效分析

Analysis of Early Clinical Outcomes of Absorbable Screws in the Treatment of Posterior Malleolar Fractures

摘要: 目的：探讨可吸收螺钉内固定治疗后踝骨折的早期临床疗效，并记录其相关并发症发生情况。方法：回顾性分析自2021年7月至2024年7月在西安交通大学附属红会医院足踝外科收治的伴有后踝骨折的踝关节骨折患者临床资料，根据纳入排除标准，最终纳入70例。根据术中内固定使用螺钉不同分为可吸收螺钉组(AS组) 38例和钛合金空心螺钉组(TS组) 32例。记录两组患者手术、住院、骨折愈合时间和并发症发生情况；采用Burwell-Charnley评级评价两组患者骨折复位质量；分别于术后3个月和末次随访时比较两组患者的美国足踝外科协会(AOFAS)踝与后足评分、疼痛视觉模拟评分(VAS)和踝背伸–跖屈活动度(range of motion, ROM)。结果：70例患者均获得12个月以上的随访，AS组随访时间13~20 (15.63 ± 2.54)个月，TS组随访时间14~22 (16.31 ± 3.27)个月，两组患者随访时间比较差异无统计学意义(P > 0.05)。两组患者年龄、性别、骨折分型等基线资料无统计学差异，具有可比性。两组间手术时间、住院时间、骨折愈合时间和并发症发生情况差异无统计学意义(P > 0.05)。两组患者的骨折复位质量比较，差异无统计学意义(P > 0.05)。两组患者在术后3个月和末次随访时美国足踝外科协会(AOFAS)踝与后足评分、疼痛视觉模拟评分(VAS)、踝背伸–跖屈ROM比较，差异均无统计学意义(P > 0.05)。TS组有24例患者术后一年取出螺钉，其中4例患者在取出时出现螺钉滑丝，1例发生螺钉断裂。70例患者均未出现明显踝关节退变、皮肤坏死、排异反应、血管神经损伤、骨折延迟愈合或不愈合及术后骨折块移位等并发症。结论：可吸收螺钉可以达到和钛合金空心螺钉类似的临床疗效，同样可以进行术后早期踝关节功能锻炼康复。由于使用了可吸收螺钉，不需要二次取出，减少了患者术后二次创伤及费用。

Abstract: Objective: This study aimed to investigate the early clinical efficacy of internal fixation using absorbable screws for posterior malleolar fractures and to document the associated complications. Methods: A retrospective analysis was conducted on clinical data from patients with ankle fractures involving the posterior malleolus treated in the Department of Foot and Ankle Surgery of Honghui Hospital Affiliated to Xi’an Jiaotong University between July 2021 and July 2024. Based on inclusion and exclusion criteria, 70 patients were ultimately enrolled. According to the type of screws used for internal fixation, patients were divided into an absorbable screw group (AS group, n = 38) and a titanium alloy cannulated screw group (TS group, n = 32). Operative time, hospital stay, fracture healing time, and complications were recorded for both groups. Fracture reduction quality was evaluated using the Burwell-Charnley rating system. The American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Visual Analog Scale (VAS) for pain, and ankle dorsiflexion-plantarflexion range of motion (ROM) were compared between the two groups at 3 months postoperatively and at the final follow-up. Results: All 70 patients were followed up for over 12 months. The follow-up period was 13~20 (15.63 ± 2.54) months in the AS group and 14~22 (16.31 ± 3.27) months in the TS group, with no statistically significant difference (P > 0.05). No significant differences were found in baseline characteristics such as age, gender, or fracture type between the two groups, indicating comparability. There were no statistically significant differences between the two groups in operative time, hospital stay, fracture healing time, or the incidence of complications (P > 0.05). The quality of fracture reduction showed no statistically significant difference between the groups (P > 0.05). No statistically significant differences were observed in the AOFAS Ankle-Hindfoot Score, VAS pain score, or ankle dorsiflexion-plantarflexion ROM between the two groups at 3 months postoperatively or at the final follow-up (P > 0.05). In the TS group, 24 patients underwent screw removal one year postoperatively; among them, 4 experienced screw thread stripping during removal, and 1 had screw breakage. None of the 70 patients exhibited significant complications such as ankle joint degeneration, skin necrosis, rejection reaction, neurovascular injury, delayed union, nonunion, or postoperative fracture fragment displacement. Conclusion: Absorbable screws can achieve clinical outcomes similar to those of titanium alloy cannulated screw and similarly allow for early postoperative ankle functional exercise and rehabilitation. The use of absorbable screws eliminates the need for secondary removal surgery, thereby reducing secondary trauma and costs for patients.