新型下胫腓联合弹性钩钢板治疗急性下胫腓联合损伤的回顾性研究

Retrospective study on Acute Syndesmosis Injury by the Treatment of Elastic Syndesmosis Hook Plate

目的：探讨新型下胫腓联合弹性钩钢板治疗急性下胫腓联合损伤的临床疗效。方法：回顾性分析2011年2月至2013年7月在本院收治的60例合并有下胫腓联合损伤的踝关节周围骨折病例。行新型下胫腓联合弹性钩钢板内固定下胫腓联合32例：男20例,女12例;年龄20-58岁,平均（38.2±3.7）岁。AO皮质螺钉内固定下胫腓联合28例：男17例,女11例;年龄17-55岁,平均（37.2±4.0）岁。术后常规行X片检查。结果：所有患者均获得门诊随访,随访时间为8-24月,平均（18.0±4.3）月,弹性钩钢板组均未出现血管损伤、感染、骨折不愈合、内固定断裂及固定失败等并发症,下胫腓弹性钩钢板取出后,无1例出现下胫腓关节再分离;AO螺钉组在术后8-12周发现2例螺钉断裂。术后踝关节功能根据Baird-Jackson评分系统评定,其中弹性钩钢板组优75%（24/32）,良12.5%（4/32）,可9.3%（3/32）,差3.1%（1/32）,优良率为87.5%;AO螺钉组优57.1%（16/28）,良14.3%（4/28）,可17.9%（5/28）,差10.7%（3/28）,优良率为71.4%.两组优良率比较差异有统计学意义（P〈0.05）。结论：新型下胫腓联合弹性钩钢板保留了下胫腓关节的微动生理特点,复位固定效果可靠、操作简单、并发症少,是一种值得推荐的有效的内固定治疗方法。

Objective：To investigate the clinical effect of elastic syndesmosis hook plate for treating the acute syndesmosis injury.Methods：All 60 cases with the acute syndesmosis injury of ankle fractures around were retrospectively analyzed from February2011 to July 2013.They were treated with open fixation by the elastic syndesmosis hook plate（20men and 12 women,with 38.2±3.7years averagely）and AOcortical screws（17men and 11 women,with 37.2±4.0years averagely）.Postoperative X-rays examination was performed.Results：All patients were followed-up for 8to 24 months,with 18.0±4.3months averagely.There were no complications occurred in elastic syndesmosis hook plate group,including injuries to the blood vessels and nerves,infection,fracture nonunin,internal fixation fracture and fixation failure,No case appeared separation of tibiofibular syndesmosis after elastic syndesmosis hook plate removal.There were 2cases of screw broken at 8to 12 weeks after operation in AO screw group.According to the Baird-Jackson criteria,in elastic syndesmosis hook plate gruop,24 cases were excellent,4cases were good,3cases were fair,and one case was poor,the excellent and good rate was 87.5%;In AO screws group,16 cases were excellent,4cases were good,5cases were fair,and 3cases were poor,the excellent and good rate was 71.4%,which was significantly different between the two groups（P〈0.05）.Conclusion：Elastic syndesmosis hook plate is more in line with the physiological micromotion characteristics of distal tibiofibular syndesmosis,which is proved to be an effective internal fixation treatment with simple operation and fewer complications.