三种螺钉固定方式治疗下胫腓联合分离对踝关节功能影响的比较研究

Research of different influences on ankle function after different kinds of distal syndesmosis fixation

目的评估应用螺钉穿透三层或四层皮质治疗下胫腓联合分离对踝关节术后功能的影响。方法将重庆市涪陵区人民医院骨科2012年6月—2015年9月收治的32例踝关节骨折合并下胫腓联合分离损伤的患者作为研究对象,所有患者随机分为三组,第1组采用1枚螺钉穿透三层皮质固定下胫腓联合(12例),第2组采用1枚螺钉穿透四层皮质固定下胫腓联合(12例),第3组采用2枚螺钉穿透三层皮质固定下胫腓联合(8例)。记录患者骨折类型、住院时间、住院费用及术后踝关节功能评分。结果所有患者均顺利完成手术,并得到术后随访,最终随访时间为术后1年。三组患者术后踝关节Olerud-Molander评分、踝关节活动度以及平均住院时间(12.03±2.0)d,差异无统计学意义(P>0.05);在住院费用上,第1组(1.07±0.2)万元和第2组(1.09±0.3)万元,明显少于第3组(1.4±0.2)万元,差异有统计学意义(P<0.05)。结论不同固定方式对术后踝关节功能无显著影响,单颗螺钉固定效果良好,且患者总体费用少,适用于基层单位。

Objective To assess the influence of tricortical or quadricortical syndesmotic screw fixation on ankle function for treating separation of tibiofibular syndesmosis. Methods A retrospective study was conducted in which 32 patients with ankle fracture combined with distal syndesmosis injury in our hospital during Jun. 2012 and Sep. 2015 was enrolled. All the patients were divided into three teams randomly,the first team was treated with one tricortical screw（ n = 12）,the second was treated with one quadricortical screw（ n = 12）,and the third team was treated with two tricortical screws（ n = 8）. Fracture types,hospitalization stay,hospitalization cost,and functional score of ankle were recorded. Results All patients were operated successfully,and the average follow-up time was1 year. Patients in different teams had no significant difference in ankle Olerud-Molander score,ROM of the ankle and average hospitalization stay（ P〈0. 05）,but the cost in the first（ 10. 7 ± 2） thousand yuan） and the second team（ 10. 9 ± 3） thousand yuan） was significantly less than that of the third team（ 14 ± 2） thousand yuan,P〈0. 05）. Conclusion Distal syndesmosis fixation methods have no significant effect in ankle function,but the one screw fixation has significantly less cost,and it is applicable in basic medical unit.