2种方法治疗踝关节骨折合并下胫腓联合损伤临床疗效比较

Efficacy comparison of two therapies for ankle joint fracture together with distal tibifibular syndesmosis injury

目的比较下胫腓联合螺钉固定与联合修复下胫腓前韧带和固定后踝骨折治疗踝关节骨折合并下胫腓联合损伤的临床疗效。方法将45例踝关节骨折合并下胫腓联合损伤患者随机分为A组(20例)和B组(25例)。2组均采用连续硬膜外麻醉、踝关节骨折复位固定的常规治疗,A组在常规治疗的基础上采用下胫腓联合螺钉固定治疗,B组在常规治疗的基础上采用联合修复下胫腓前韧带和固定后踝骨折治疗,2组均给予术后处理。术后1年比较2组的优良率,术后第2天及术后1年比较2组下胫腓重叠距离。结果 A组优良率为95.0%,B组为96.0%,2组比较差异无统计学意义(P>0.05);2组术后第2天及术后1年下胫腓重叠距离组内与组间比较,差异均无统计学意义(P>0.05)。结论与下胫腓联合螺钉固定相比,联合修复下胫腓前韧带和固定后踝骨折避免了二次手术取出螺钉以及螺钉断裂的风险,能更好地恢复踝关节下胫腓联合的解剖结构及生物弹性,是治疗踝关节骨折合并下胫腓联合损伤的一种有效方法。

Objective To compare the efficacy of screw fixation of the injured syndesmosis,repair of anterior lower tibiofibular ligament combining fixation of ankle for ankle joint fracture together with distal tibifibular syndesmosis injury. Methods 45 patients were randomly divided into Group A（ 20 cases） and Group B（ 25 cases）.Continuous epidural anesthesia（ CEA） and reduction fixation of ankle joint fracture were taken as regular treatment. Based on that,Group A was intervened with screw fixation of the injured syndesmosis; Group B was given repair of anterior lower tibiofibular ligament and fixation of ankle. postoperative management was given to both groups.Good rates of two groups were compared at 1-year post-operation period,TBOL were compared at 2-day and 1-year follow-up. Results Good rate in Group A was 95.0%,while in Group B was 96.0%,there was no difference（ P〉 0.05）; for TBOL,no any statistical difference was in one group or between groups（ P〉 0.05）. Conclusion Compared with the screw fixation of the injured syndesmosis,the combined therapy can avoid the risk of screw removal and screw breakage in the second operation,it is an effective method for ankle joint fracture together with distal tibifibular syndesmosis injury by restoring the bioflexibility of ankle joint.