弹性固定及坚强固定治疗踝关节旋前-外旋型骨折合并下胫腓联合分离的疗效比较

Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis

目的通过与坚强固定比较,分析弹性固定治疗踝关节旋前-外旋型骨折合并下胫腓联合分离的疗效及优势。方法回顾分析2013年1月—2015年12月收治并符合选择标准的50例踝关节旋前-外旋型骨折伴下胫腓联合分离患者临床资料,其中23例采用缝线钢板系统弹性固定(弹性固定组),27例采用皮质骨螺钉坚强固定(坚强固定组)。两组患者年龄、性别、体质量、骨折侧别及类型、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。记录并比较两组手术时间及术后内侧关节间隙(medial clear space,MCS)、下胫腓关节间隙(tibiofibular clear space,TFCS)、胫腓骨重叠(tibiofibular overlap,TFO)、美国矫形足踝协会(AOFAS)评分和足踝功能障碍指数(FADI)评分。结果弹性固定组手术时间为(83.0±9.1)min,坚强固定组为(79.6±13.1)min,两组比较差异无统计学意义(t=1.052,P=0.265)。所有患者术后切口均Ⅰ期愈合。两组患者均获随访,随访时间12~20个月,平均14个月。X线片复查示,两组骨折均愈合,无螺钉断裂、骨折延迟愈合或不愈合等发生;弹性固定组骨折愈合时间为(12.1±2.5)个月,坚强固定组为(11.3±3.2)个月,两组比较差异无统计学意义(t=1.024,P=0.192)。坚强固定组2例患者取出下胫腓螺钉后出现复位丢失。末次随访时,两组MCS、TFCS、TFO及AOFAS评分、FADI评分比较,差异均无统计学意义(P>0.05)。结论采用缝线钢板系统对踝关节旋前-外旋型骨折合并的下胫腓联合分离进行弹性固定,术后踝关节功能及影像学结果与螺钉坚强固定相似,同时避免了下胫腓联合复位丢失。

Objective To compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis. Methods A retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients （flexible fixation group） and cortical screw fLxation in 27 patients （rigid fixation group）. There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups （P〉0.05）. The operation time, medial clear space （MCS）, tibiofibular clear space （TFCS）, tibiofibular overlap （TFO）, American Orthopaedic Foot and Ankle Society （AOFAS） score, and Foot and Ankle Disability Index （FADI） score were compared between 2 groups. Results The operation time was （83.0±9.1） minutes in the flexible fixation group and was （79.6±13.1） minutes in the rigid fixation group, showing no significant difference （t= 1.052, P=0.265）. All patients achieved healing of incision by first intention. The patients were followed up 12-20 months （mean, 14 months）. The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was （12.1±2.5） months in the flexible fixation group and was （11.3±3.2） months in the rigid fixation group, showing no significant difference between 2 groups （t= 1.024, P=0.192）. Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups （P〉0.05）. Conclusion Suture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.