关键词: 骨折；骨折固定术, 内；关节镜

Abstract:

Objective  To investigate the effect of arthroscopic-assisted closed reduction and percutaneous internal fixation in ankle fracture and its effect on the postoperative American Orthopedic foot and Ankle Society(AOFAS) score, bone metabolic markers and trauma response.

Methods  The clinical data of 109 patients with ankle fracture in our hospital were analyzed retrospectively. According to different surgical methods, they were divided into arthroscopy group(n=55) and conventional group(n= 54). The conventional group was given conventional open reduction and internal fixation, and the arthroscopic group was given arthroscopic-assisted closed reduction and percutaneous internal fixation. The operation-related indexes, trauma response indexes ［C-reactive protein(CRP), interleukin-8(IL-8), cortisol(Cor), norepinephrine(NE)］ before operation, and at 1 d and 3 d after operation, and the levels of bone metabolic markers［bone γ-carboxyglutamic acid-containing protein(BGP),bone alkaline phosphatase(BALP), β-collagen degradation products(β-CTX)］ before operation, and at 2 weeks and 4 weeks after operation were compared between two groups.The incidence of complications, muscle strength of ankle plantar flexion and dorsiflexion, active range of motion(AROM), AOFAS score and Generic Quality of Life Inventory-74(GQOL-74) were calculated before operation, and at 3 months and 6 months after operation.

Results  The amount of intraoperative bleeding in arthroscopy group was lower than that in conventional group, and the duration of operation, length of hospital stay and fracture healing time were shorter than those in conventional group(P＜0.05). The serum CRP, IL-8, Cor and NE at 1 d and 3 d after operation and serum β-CTX level at 2 weeks and 4 weeks after operation were lower in arthroscopy group than in the conventional group, while the levels of serum BGP and BALP were higher than those in the conventional group at 2 and 4 weeks after operation(P＜0.05). The incidence of postoperative complications in arthroscopy group was 3.64%, which was lower than that (16.67%) in conventional group(P＜0.05). At 3 and 6 months after operation, the muscle strength of ankle plantar flexion and dorsiflexion, AROM and AOFAS and GQOL-74 scores in arthroscopy group were higher than those in conventional group(P＜0.05).

Conclusion  Arthroscopic-assisted closed reduction and percutaneous internal fixation in the treatment of ankle fracture can reduce surgical trauma, promote postoperative recovery, reduce complications, improve bone metabolism, and improve ankle function and quality of life. Therefore, it is of high application value.

Key words: fractures, fracture fixation, internal； arthroscope