纽扣钢板与皮质骨螺钉治疗下胫腓联合分离的疗效比较

A comparison of efficacy between suture button plate and cortical screw in the treatment of distal tibiofibular syndesmosis seperation

目的探讨应用纽扣钢板与皮质骨螺钉治疗下胫腓联合分离的临床疗效。方法回顾性收集2011年3月—2014年5月收治的下胫腓联合分离伴或不伴踝关节骨折患者的病历资料及其术后第1、2、4、6周及第3、6、12个月门诊随访资料。根据患者的下胫腓联合固定方式分为纽扣钢板组和皮质骨螺钉组,比较两组患者的手术时间、术中出血量、合并踝关节骨折愈合时间、末次随访时踝关节功能及并发症发生情况。结果共纳入患者52例,其中纽扣钢板组28例,皮质骨螺钉组24例。两组患者的手术时间、术中出血量比较差异均无统计学意义(P>0.05)。所有患者均获得随访,随访时间12~30个月,平均14.5个月,切口均Ⅰ期愈合。随访见纽扣钢板组合并踝关节骨折愈合时间为(11.2±2.0)周,皮质骨螺钉组合并踝关节骨折愈合时间为(11.0±2.1)周,两组比较差异无统计学意义(P>0.05)。纽扣钢板组未发生内固定松动、断裂,1例于术后3周发现下胫腓联合再分离,经再次手术固定治愈。皮质骨螺钉固定组分别于术后第9、11周出现下胫腓联合螺钉断裂各1例,于骨折愈合后取内固定时一并取出;1例于术后6周发生下胫腓联合再分离,因患者高龄、要求不高而未予特殊处理。末次随访时,纽扣钢板组踝关节美国骨科足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分为(84.6±10.2)分,螺钉固定组踝关节AOFAS评分为(83.7±12.5)分,两组比较差异无统计学意义(P>0.05)。结论纽扣钢板与皮质骨螺钉均能有效治疗下胫腓联合分离,纽扣钢板松动断裂风险小,术后早期可开始功能锻炼,无需常规再次手术取出。

Objective To investigate the clinical efficacy between suture button plate and cortical screw in the treatment of distal tibiofibular syndesmosis seperation. Methods The clinical data and follow-up data 1 week and 2, 4,6 weeks and 3, 6, 12 months after operation of patients with distal tibiofibular syndesmosis seperation combined with or without ankle fracture who were admitted to hospital from March 2011 to May 2014 were retrospectively collected.According to the fixation ways of distal tibiofibular syndesmosis, the patients were divided into the suture button plate group and the cortical screw group. The operation time, amount of blood loss, combined ankle fracture healing time,American Orthopaedic Foot and Ankle Society（AOFAS） scores at the last follow-up and complications were compared between the two groups. Results A total of 52 patients were enrolled, including 28 cases of suture button plate group and24 cases of cortical screw group. There were no significant difference in operation time or amount of blood loss between the two groups（P〉0.05）. All patients were followed up for 12–30 months averaged 14.5 months. All incisions healed by the first intention. The combined ankle fracture healing time in the suture button plate group was（11.2±2.0） weeks, while that was（11.0±2.1） weeks in the cortical screw group, with no significant difference between the two groups（P〉0.05）. In the suture button plate group, there was no loosening or rupture of internal fixation, while distal tibiofibular syndesmosis seperation was found again in one case 3 weeks after operation, and cured by reoperation at last. In the cortical screw group,rupture of screws was found in 2 cases, which occurred 9 and 11 weeks after operation respectively, and the broken screws were taken out when the fractures were healed and the internal fixation was removed; distal fibiofibular syndesmosis seperation was found again in one case 6 weeks after operation, and no treatment was given due to old age and low demand. At the last follow-up, the AOFAS score in the suture button plate group was 84.6±10.2, while the score in the cortical screw group was 83.7±12.5, with no significant difference between the two groups（P〉0.05）. Conclusions Suture button plate and cortical screw can effectively treat distal fibiofibular syndesmosis separation. The risk of suture button plate loosening or rupture is poor. Suture button plate fixation can meet the need of early functional exercises, and avoid the routine removal by reoperation.