| Objective: This topic through the analysis of three Haraguchi type I in ankle fractures after ankle fracture fixed way to explore the clinical efficacy of different optimum fixed way after ankle fracture,and the factors on the issues involved in the utilization of ankle postoperative outcomes were analyzed,and concluded that can affect the ankle independent risk factors for postoperative outcomes,so as to provide reference for clinical application.Methods: Retrospective analysis was performed on 87 patients with trimalleolus fracture admitted to orthopaedic trauma department of Affiliated Hospital of Qing Hai University from September 2015 to March 2021,and the classification of posterior malleolus fracture was Haraguchi TYPE I.Among them,81 cases were effectively followed up,and 41 cases were treated with screw as posterior malleolus internal fixation(screw group).There were 40 cases of posterior malleolus internal fixation with plate(plate group).Patients in the screw group and plate group received the same anesthesia(lumbar anesthesia combined with epidural anesthesia),Through comparing analysis of two groups of patients in the general information(patients’ age,gender,injury mechanism,the injured area),surgery related index(ankle after the edge of the lateral length,associated with the ankle after operation time,intraoperative blood loss,surgical related fees),postoperative complications,fracture healing time,the American association of ankle surgery(American Differences in Orthpedic Foot and Ankle Society(AOFAS)Ankle-hindfoot function scores and Ankle Range of motion(ROM)measurements.The ankle-hind foot function score of the last AOFAS was taken as the efficacy evaluation index,and dichotomous variables were set.The score ≥90 was defined as excellent function group,and the score < 90 was defined as average function group.The factors influencing the prognosis of ankle arthroplasty were analyzed by different methods of posterior malleolus fixation,patient’s age,gender,injury mechanism,length of anterolateral incision,operation time related to posterior malleolus,intraoperative blood loss,fracture healing time,postoperative complications and other factors.Result: Patients in the two groups were followed up in stages,at 6 and 12 months,respectively.Statistical analysis showed no difference in age(43.8±17.5years VS 44.1±15.5 years),male to female ratio(24:17 VS 27:13),the proportion of low energy injury(sprain),high energy injury(high fall and car accident)(25:16 VS27:13)and left and right ankle ratio(16:25 VS 18:22)(P > 0.05).In the comparison of surgical indicators,Statistical analysis showed differences in the operation time of posterior malleolus in the screw group and the plate group(22.5±2.7min VS27.7±2.8min),and the intraoperative blood loss(74.0±10.9ml VS81.6±12.1ml),surgical cost(35119.8±3995.6 yuan VS 44604.1±4145.8 yuan)and fracture healing time(11.4± 1.1mon VS 10.0± 0.9mon)(P < 0.05).Statistical analysis showed no difference in the anterolateral incision length between the screw group and the plate group(11.1±0.7cm VS 11.4±0.8cm)(P > 0.05).In the process of comparing postoperative complications,there was 1 case of internal fixation loosening(2.4%),1case of traumatic arthritis(2.4%),no postoperative incision infection(0%)and malunion(0%)in the screw group at 6 months after surgery,and the total incidence was about 4.9%.In the steel plate group,there was 1 case of incision infection(2.5%),no loosening of internal fixation(0%),traumatic arthritis(0%)and malunion(0%)on the third day after surgery,and the total incidence was about 2.5%.Statistical analysis showed no difference in the total rate of complications between the two groups(P >0.05).AOFAS ankle-posterior foot function score(AOFAS)in the screw group(86.2±3.3 points VS 90.5±2.3 points)and in the steel plate group(86.5±2.3 points VS90.7±2.7 points)were statistically different between 6 and 12 months after operation(P < 0.05).There was no difference between the screw group and the steel plate group6 months after surgery(86.2±3.3 points VS 86.5±2.3 points)and 12 months after surgery(90.5±2.3 points VS 90.7±2.7 points).The dorsiflexion Angle of the screw group was(19.9±2.4°VS 20.2±2.1°),the plantar-flexion Angle was(39.0±3.3°VS38.4±3.0°),and the varus Angle was(22.2±3.5°VS21.1±3.0°).There was no difference in valgus Angle(25.8±3.2°VS 26.7±3.0°)(P >0.05).Different fixation methods(P=0.932),patient’s age(P=0.036),gender(P=0.901),injury mechanism(P=0.012),incision length of anterolateral ankle incision(P=0.822),operation time related to anterolateral ankle(P=0.896),intraoperative blood loss(P=0.716),fracture healing time(P=0.023),postoperative complications(P=0.636)and other factors were selected by single factor screening and considering the major.The selected variables were patient’s age,injury mechanism and fracture healing time.Multivariate logstic regression analysis revealed that the final independent risk factors for postoperative ankle outcomes were patient age(P=0.015),mechanism of injury(P=0.007),and time to fracture healing(P=0.048).Conclusion: For Haraguchi type I posterior malleolus fracture among three malleolus fractures,the screw group was superior to the plate group in terms of operation time,intraoperative blood loss and surgical cost,and the plate group was superior to the screw group in terms of fracture healing time.AOFAS ankle-posterior foot function evaluation in the screw group and the plate group was superior to that in the screw group at 12 months after surgery than that at 6 months after surgery.After single-factor screening,a multifactor logstic regression analysis showed that the patient’s age,injury mechanism and fracture healing time were independent risk factors affecting the prognosis of postoperative ankle joint.The older the patient is,the longer the fracture healing time is and the worse the prognosis is with high energy injury. |
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