新型下胫腓联合弹性钩钢板与传统下胫腓钩内固定治疗下胫腓联合损伤的临床疗效比较

Comparison of elastic syndesmosis hook plate and ordinary syndesmosis hook in the treatment of Syndesmosis injury

目的：探讨自行设计的一种新型下胫腓联合弹性钩钢板（ESHP）与传统下胫腓钩（OSH）内固定治疗下胫腓联合损伤的临床疗效。方法选择2011年2月—2012年2月解放军第175医院（厦门大学附属东南医院）全军骨科中心收治的51例下胫腓联合损伤的患者进行前瞻性对照研究,对入院日期为奇数的27例患者采用 ESHP 治疗（ESHP 组）、为偶数的24例患者采用 OSH 治疗（OSH 组）,比较两组患者的手术时间、术中出血量、手术切口长度、住院时间,术后1年按 Baird-Jackson 评分系统进行疗效评定,比较两组患者优良率。结果51例患者均顺利完成手术,ESHP 组术中出血量（22.5±5.6）mL,少于 OSH 组的（28.5±6.0）mL,差异有统计学意义（t =-5.593,P 〈0.05）；而手术时间、切口长度、住院时间差异均无统计学意义（t 值分别为-1.571、0.539、-0.476,P值均〉0.05）。患者均获随访,随访12~36个月,平均26.5 个月。随访期间骨折均一期愈合,未发生感染、骨不连、骨折畸形愈合及内固定断裂等并发症。 ESHP 组和 OSH 组患者均于术后8个月~1年取除踝关节骨折钢板及下胫腓联合内固定物,取除术后均未出现下胫腓联合再分离及固定失效等并发症。术后1年按 Baird-Jackson 评分系统进行疗效评定,ESHP 组优23例、良 4例,优良率100%（27/27）；OSH 组优13例、良10例、差 1例,优良率96%（23/24）。 ESHP 组优良率高于 OSH 组,差异有统计学意义（Z =2.429,P 〈0.01）。结论相比传统 OSH,ESHP 更符合下胫腓关节的微动生理特点,在促进下胫腓联合韧带的修复及踝关节术后功能恢复方面有明显优势。

Objective To compare clinical outcomes of new designed elastic syndesmosis hook plate （ESHP） and ordinary syndesmosis hook（OSH）in the treatment of Syndesmosis injury. Methods Fifty one patients with Syndesmosis injury treated in the Orthopedic Department of the 175th Hospital of PLA from February 2011 to February 2012, were divided into two groups according to odd number or even number of their hospitalization date. Patients with odd number hospitalization date were treated with elastic syndesmosis hook plate（ ESHP, n = 27）. Patients with even number hospitalization date were treated with ordinary syndesmosis hook（OSH, n = 24）. The operation time, blood loss during operation, incision length, and hospital stay were compared. Meanwhile, Baird-Jackson scoring system was used to evaluate the treatment effect at 1 year post-operation to observe and analyze the good rate. Results The 51 patients were successfully completed surgery. The blood loss during operation of ESHP group（22. 5 ± 5. 6） mL was less than OSH group（28. 5 ± 6. 0） mL. There was significantly statistical difference between two groups （ t =- 5. 593, P 〈 0. 01）. There was no statistical difference in operation time, incision length and hospital stay between the two groups（t = - 1. 571, 0. 539, - 0. 476, all P values 〉 0. 05）. All patients were followed up for 12 - 36 months, an average of 26. 5 months. During the follow-up period, all fractures were primary healing. No complications such as infection, bone nonunion, malunion, breaking of internal fixator were found. According to Baird-Jackson scoring system 1 year after the operation, in elastic syndesmosis hook＆amp;nbsp;group, the results were excellent in 23 and good in 4, the excellent and good rate reached 100% （27 / 27）. In ordinary syndesmosis hook group, the results were excellent in 13, good in 10 and poor in 1, the excellent and good rate reached 96% （23 / 24）. there were significant differences between the 2 groups in the excellent and good rate （Z = 2. 429, P 〈 0. 05）. Conclusions Compared with OSH, ESHP is more in line with the physiological micromotion characteristics of distal tibiofibular syndesmosis, which has obvious advantages in the promotion of ligament repair and tibiofibular syndesmosis functional recovery.