踝关节骨折合并脱位急诊手术与择期手术的结果对比
A comparative research on the treatment of ankle fracture with dislocation between emergency surgery and selective surgery

目的：对比踝关节骨折合并脱位急诊手术与择期手术的效果。方法：纳入2013年5月至2014年5月积水潭医院创伤骨科急诊收治并随访的踝关节骨折合并脱位的患者40例，随机分为急诊手术组和择期手术组。对两组患者的手术时间、住院天数、治疗费用、伤口愈合、BairdJackson功能评分及术后并发症等因素进行评价，采用独立样本t检验或卡方检验进行统计推断。结果：患者的年龄范围为19~56岁，平均年龄为（37.48±12.39）岁。40例患者中，男性28例（70.00%），女性12例（30.00%）；左踝18例（45.00%），右踝22例（55.00%）；后脱位17例（42.50%），外侧脱位23例（57.50%），两组患者的年龄、性别、骨折部位和骨折分型的差异均无统计学意义。两组患者的手术时间分别为(95.0±34.1) min和(100.5±32.7) min，差异无统计学意义（t=-0.516，P=0.609）。急诊手术的住院时间和住院费用均低于择期手术组（t=-5.862、t=-3.663，P<0.001、P =0.001）。利用改良的BairdJackson评分系统进行评分，根据最后评分分为优、良、中、差4个等级。急诊手术组中优13人（65.0%），良4人（20.0%），中3人（15.0%），差0人；择期手术组优11人（55.0%），良7人（35.0%），中2人（10.0%），差0人。总体优24人（60.0%），良11人（27.5%），中5人（12.5%），两组患者的功能评分差异无统计学意义（χ2=1.235，P=0.651）。结论：踝关节骨折合并脱位早期手术与择期手术治疗效果相比并无明显差异，但急诊手术可缩短住院天数，节省患者治疗费用。
Objective：To investigate the differences between emergency surgery and selective surgery treatment of ankle fractures with dislocation. Methods: In the study, 40 patients with ankle fracture and dislocation were treated and followed up from May 2013 to May 2014, and all the data were collected and analyzed. The subjects involved 29 male patients and 11 female patients. The patients were randomly separated into two groups, and the patients in group A were given surgical intervention within 6 hours after injury, while those in group B were initially given close reduction and given selective operation when the soft tissue condition got better. Group A contained 13 male patients and 7 female patients with average age of 37.10; Group B consisted of 15 male and 5 female, with average age of 37.85. Results:The Baird-Jackson score was applied for assessment of the patients’ outcomes. According to the score, the outcomes were classified into excellent, good, fair, and poor. In group A (emergency group), the outcomes were 13 (65.0%), 4 (20.0%), 3 (15.0%), and 0, respectively. In group B (selective group), they were 11 (55.0%), 7 (35.0%), 2 (10.0%), and 0, respectively. The numbers of the patients from excellent to poor were 24 (55.0%), 11 (27.5%), 5 (12.5%), and 0, respectively. Conclusion: There is no significant difference in postoperative function between the two groups, however, early surgical intervention can benefit in accomplishing anatomical reduction much easier and shortening the time of hospitalization, which is costsaving for the patients.