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目的 比较老年人踝关节旋后外旋Ⅳ型骨折的手法整复与手术治疗效果.方法 回顾性分析青海省人民医院于2016年2月至2017年6月收治的老年踝关节旋后外旋IV型骨折患者, 按照纳入排除标准, 共有54纳入本研究, 手法整复组21人, 手术治疗组33人.评估两组治疗后12个月的Mazur踝关节症状与功能评价分级、Leeds影像学评价分级.采用秩和检验比较两组之间的差异.结果 治疗后12个月, 两组的Mazur踝关节症状与功能评价分级差异无明显统计学意义 (Z=-0.496, P>0.05);手术治疗组的Leeds影像学评价分级明显优于手法整复组, 差异具有统计学意义 (Z=-3.641, P0.05).The Leeds imaging evaluation grade of the surgical treatment group was significantly better than the manual restitution;the difference was statistically significant (Z=-3.641, P<0.01).ConclusionAt 12 months after treatment, satisfactory ankle joint symptoms and functional improvement can be obtained by both manual restitution and surgery, but the results of imaging review of the manual restitution are worse than surgery.