可吸收螺钉及金属螺钉治疗下胫腓联合损伤的疗效比较

EFFECTIVENESS COMPARISON BETWEEN ABSORBABLE AND METALLIC SCREWS FOR TREATMENT OF TIBIOFIBULAR SYNDESMOTIC DISRUPTIONS

目的 探讨可吸收螺钉替代金属螺钉治疗下胫腓联合损伤的可行性。方法 2007年7月-2012年5月,收治踝关节骨折合并下胫腓联合损伤69例。应用可吸收螺钉固定38例（A组）,金属螺钉固定31例（B组）。两组患者性别、年龄、骨折类型侧别、受伤至手术时间等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。记录两组患者下地负重时间,X线片复查骨折愈合情况,比较两组并发症发生情况,术后6个月采用Baird-Jackson评定标准评定踝关节功能。结果 术后A组3例（7.9%）、B组2例（6.5%）切口感染,A组1例（2.6%）、B组5例（16.1%）切口皮肤坏死,余患者切口均Ⅰ期愈合;两组切口感染及皮肤坏死发生率比较差异均无统计学意义（P〉0.05）。69例均获随访,随访时间12～26个月,平均18.6个月。A、B组下地负重时间分别为（2.97±0.59）、（3.16±0.74）个月,比较差异无统计学意义（t=1.175,P=0.244）。X线片示骨折及下胫腓联合损伤均愈合;A、B组愈合时间分别为（5.71±1.01）、（5.81±1.08）个月,比较差异无统计学意义（t=0.381,P=0.705）。两组均无内固定失效及螺钉松动、断裂等并发症发生。术后6个月,按Baird-Jackson评定标准评价踝关节功能,A组获优29例、良5例、可4例,优良率为89.5%;B组获优20例、良7例、可4例,优良率为87.1%;两组比较差异无统计学意义（Z=-0.991,P=0.321）。结论 可吸收螺钉内固定能有效治疗下胫腓联合损伤,优良率与金属螺钉固定相似,且无需二次手术取出。

Objective To investigate the feasibility and effectiveness of absorbable screws for the treatment of tibiofibular syndesmotic disruptions by comparing with metallic screws. Methods Between July 2007 and May 2012, 69 patients with tibiofibular syndesmotic disruptions associated with ankle fractures were treated; absorbable screw fixation was used in 38 cases （group A） and metallic screw fixation was used in 31 cases （group B）. There was no significant difference in gender, age, injury causes, the type of fracture, the side of fracture, and disease duration between 2 groups （P 〉 0.05）. The fracture healing time, weight bearing time, and complications were recorded and compared between 2 groups. According to Baird-Jackson scoring system, the function of the ankle was assessed after 6 months. Results Infection of incision occurred in 3 cases （7.9%） of group A and 2 cases （6.5%） of group B, and skin necrosis of incision in 1 case （2.6%） of group A and 5 cases （16.1%） of group B, showing no significant difference in the incidences of infection and necrosis of incisions between 2 groups （P 〉 0.05）; primary healing of incision was obtained in the other patients. The 69 cases were followed up 12-26 months （mean, 18.6 months）. The weight bearing time was （2.97±0.59） months in group A and was （3.16±0.74 ） months in group B, showing no significant difference （t=1.175, P=0.244）. X-ray films showed that fractures and tibiofibular syndesmotic disruptions healed in 2 groups; the healing time was （5.71 ±1.01） months in group A and was （5.81±1.08） months in group B, showing no significant difference （t=0.381, P=0.705）. No fixation failure, breakage, or loosening occurred in 2 groups. According to Baird- Jackson scoring system, the results were excellent in 29 cases, good in 5 cases, and fair in 4 cases with an excellent and good rate of 89.5% in group A at 6 months after operation; the results were excellent in 20 cases, good in 7 cases, and fair in 4 cases with an excellent and good rate of 87.1% in group B; no significant difference was found in the excellent and good rate between 2 groups （Z= 0.991, P=0.321）. Conclusion Treatment of tibiofibular syndesmotic disruptions with absorbable screws can get good effectiveness and replace metallic screws because of avoiding additional operation for removing the screw.