Endobutton与螺钉内固定治疗下胫腓联合分离的临床疗效分析

Endobutton and cortical screw fixation for the treatment of distal tibiofibular syndesmosis separated

目的 ：探讨采用Endobutton纽扣钢板线缆系统与皮质骨螺钉内固定治疗下胫腓联合韧带损伤分离的临床疗效。方法：回顾性分析2011年10月至2013年10月,手术治疗的38例踝关节骨折合并下胫腓联合分离者患者,按术中内固定材料,分为皮质螺钉内固定（A组）和Endobutton纽扣钢板线缆系统固定（B组）。其中A组26例,男16例,女10例;年龄19~63岁,平均（37.90±4.67）岁;左侧14例,右侧12例;按Danis-Weber分型：B型8例,C型18例;按照Lauge-Hanson分型：旋后外旋（SER）9例,旋前外展（PAB）10例,旋前外旋（PER）7例。B组12例,男7例,女5例;年龄20~55岁,平均（38.70±6.03）岁;左侧6例,右侧6例;按Danis-Weber分型：B型4例,C型8例;按Lauge-Hanson分型：旋后外旋3例,旋前外展2例,旋前外旋7例。记录并比较两组患者手术时间、术中出血量、手术费用、住院时间、术后1个月疼痛评分、创口愈合情况及术后负重时间,定期复查X线片评估两组患者骨折愈合情况。术后采用美国足踝外科协会（AOFAS）踝与后足评分系统对患者进行踝关节功能评价。结果：38例患者获得随访,时间8~18个月,平均13.5个月。术后A组比B组的手术时间更长、经济费用更高（P〈0.05）;两组患者术中失血量、住院时间、术后1个月疼痛评分、负重时间比较差异无统计学意义（P〉0.05）;两组的胫腓骨重叠宽度、胫腓骨间隙、内踝间隙比较差异无统计学意义（P〉0.05）。术后X线片随访,A组骨折愈合良好,1例患者术后8周螺钉断裂,踝穴无移位,B组病例骨折愈合良好,无装置脱落,踝穴无移位。术后AOFAS评分：A组（87.50±8.67）分,优18例,良4例,可4例;B组（86.23±7.42）分,优7例,良4例,可1例。两组AOFAS评分比较差异无统计学意义（P〉0.05）。结论 ：Endobutton纽扣钢板线缆系统是一种治疗下胫腓联合韧带损伤分离的弹性固定装置,其固定效果与螺钉内固定相似,但避免了螺钉断裂风险,术后无须常规取出,有利于患者提前进行负重功能锻炼。

Objective：To analyze the treatment effect of Endobutton plate cable system for the treatment of the distal tibiofibular syndesmosis injury. Methods：Total 38 patients with tibiofibular syndesmosis separation treated by surgical operation from October 2011 to October 2013 were analyzed retrospectively. According to internal fixation,38 cases were divided into two groups involving group A（cortical screw fixation） and group B（Endobutton plate cable system fixation）. In group A,there were 26 patients including 16 males and 10 females with an average age of（37.90±4.67） years old ranging from 19 to 63 years old; 14 cases were on the left and 12 on the right;involving 8 cases of Weber-Denis type B,18 cases of Weber-Denis type C; according to Lauge-Hanson typing,9 cases of supination external rotation（SER）,10 cases of pronation abduction（PAB）,7 cases of pronation external rotation（PER）. In group B,there were 12 cases including 7 males and 5 females,with an average age of（38.70±6.03） years old ranging from 20 to 55 years old;6 cases were on the left and 6 cases on the right;involving 4 cases of Weber-Denis type B and 8 cases of Weber-Denis; involving 7 cases of PER,3 cases of SER,2 cases of PAB. The operative time,intraoperative blood loss,surgery cost,hospital stay time,the wound healing,pain score at 1 month after operation,and the load time were recorded and evaluated. According to reviewing of X rays regulary,the healing of fracture were assessed,the function outcomes of ankle was evaluated according to the Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society. Results：All patients were followed up for 8 to 18 months with an average of 13.5 months.There were no statistical significance in intraoperative blood loss,hospital stay time,average load time and postoperative pain score at 1 month after operation between two groups（P 0.05）. Duration of operation,the operative time were significantly shorter in cortical screw group;however,the average cost of hospitalization was significantly higher in Endobutton group. No significant differences were found between two groups in outcome of radiographic measurement. The X rays of 36 patients showed well healing of fracture,normal mortise and no distal tibiofibular syndesmosis separation. AOFAS score at the final follow up in group A was（87.50±8.67） scores,18 cases got excellent result,4 cases were good,and 4 cases were fair. AOFAS score at the final follow up in group B was（86.23±7.42） scores,7 cases obtained excellent result,4 cases were good and 1 case was fair; AOFAS score between two groups were no significant difference（P〉0.05）. Conclusion：Endobutton plate cable system is a dynamic capital equipment in treating the tibiofibular syndesmosis separation,it has a similar outcome compared with the screw,but without screw fractured and do not regular remove after operation. The patients could take the functional exercises earlier.