踝关节骨折术后微创取出下胫腓螺钉对踝穴间隙的影响

Effect of minimally invasive removal of syndesmotic screw on mortise clear space after ankle fracture surgery

目的：探讨踝关节骨折术后8-12周微创取出下胫腓螺钉对踝穴间隙及踝关节稳定性的影响。方法以踝关节骨折术后伤口愈合良好的40例患者为研究对象，采用体表标记摄片定位微创技术于术后8-12周取出其下胫腓螺钉，分析下胫腓螺钉取出对40例患者踝穴间隙的影响。结果40例患者术后切口均Ⅰ期愈合，无感染、螺钉断裂、滑丝、取出困难及下胫腓联合再分离等并发症，术后7-14 d完全负重行走。40例患者均获随访，随访时间8-26个月。40例患者术后1个月疼痛显著缓解。术前、术后1个月、踝关节内固定装置完全拆除后及末次随访时的胫腓骨重叠距离（F＝0.626，P＝0.599）、胫腓骨间隙（F＝1.023，P＝0.385）、内踝间隙（F＝1.983，P＝0.132）比较差异均无统计学意义。疼痛视觉模拟评分由术前的（4.5＆#177;0.1）分降至末次随访时的（1.0＆#177;0.1）分（P＜0.008）；美国足与踝关节协会踝与后足功能评分由术前的（69.6＆#177;0.9）分提高至末次随访时的（87.5＆#177;0.6）分（P＜0.008）。结论踝关节骨折术后8-12周微创取出下胫腓螺钉对踝穴间隙及踝关节稳定性的影响小。

Objective To evaluate the effect of minimally invasive removal of syndesmotic screw upon ankle mortise clear space and ankle joint stability after ankle fracture surgery. Methods Forty patients who underwent body surface landmark-assisted minimally invasive removal of syndesmotic screw and were well healed after ankle fracture surgery were recruited in this study. Body surface landmark-assisted minimally invasive removal of syndesmotic screw was performed at 8 to 12 weeks after ankle fracture surgery and the effect upon mortise clear space was assessed in 40 cases. Results Stage I wound healing was achieved in 40 patients without postoperative complications of infection,breakage or slip of screw or difficulty of screw removal and syndesmotic recurrences. The time of full weight-bearing walk was 7 to 14 d after surgery. Forty patients were followed up for 8 to 26 months. The severity of pain was significantly alleviated at postoperative 1 month in all cases. The tibiofibular overlap distance （F=0.626,P=0.599）,the tibiofibularclear space （F=1.023,P=0.385）and the medial clear space （F=1.983,P=0.132）did not significantly differ among before surgery, at postoperative 1 month,at the time of removal of fixation plate and the final follow-up. The mean visual analogue scale （VAS）score was 4.5 ±0.1 before surgery,significantly decreased to 1.0 ±0.1 at the final follow-up （P〈0.008）. American Orthopedic Foot and Ankle Society Score （AOFAS）was 69.6 ±0.9 before surgery,significantly increased to 87.5 ±0.6 at the final follow-up （P〈0.008）. Conclusion At 8 to 12 weeks after ankle fracture surgery,minimally invasive removal of syndesmotic screw exerts mild effect upon mortise clear space and ankle joint stability.