骨膜移位法在改善踝关节骨折合并下胫腓联合分离患者踝关节功能中的应用

Periosteum shift method for improving ankle joint function in ankle fractures combined inferior tibiofibular syndesmosis separation

目的探讨骨膜移位法在改善踝关节骨折(ankle fractures,AF)合并下胫腓联合分离(inferior tibiofibular syndesmosis separation,ITSS)患者踝关节功能中的应用。方法选取2013年12月—2016年12月保定法医医院确诊治疗的AF合并ITSS患者100例,依据治疗方法分为A组和B组,每组50例,A组给予短肌腱移位法治疗,B组给予骨膜移位法治疗。结果 B组手术、住院、骨折愈合时间低于A组,B组术后3个月美国矫形外科足踝协会足功能评分系统(AOFAS)得分、踝关节功能优良率高于A组,差异有统计学意义(P<0.05),但A组和B组术中出血量、并发症发生率、术后6个月AOFAS得分、踝关节功能优良率基本相同,差异无统计学意义(P>0.05)。结论与短肌腱移位法比较,骨膜移位法对AF合并ITSS患者并发症和远期踝关节功能无明显改善作用,但可有效减少患者手术和术后恢复时间,有利于改善患者近期踝关节功能。

Objective To discuss the applicability of the periosteum shift method for improving the ankle joint function in ankle fracture (AF) with inferior tibiofibular syndesmosis separation (ITSS). Methods One hundred patients with AF combined with ITSS were selected between December 2013 and December 2016 at Baoding Medical Examiner Hospital. According to the treatment method, all these patients were divided into group A and group B, with 50 in each group. Group A was treated with the short tendon shift method, while group B was treated with the periosteum shift method. Results The duration of surgery, hospital stay, fracture healing time of group B were significantly longer than in group A. Three months after treatment, the scores based on the American Orthopedic Foot Ankle Society(AOFAS)foot function scoring system and ankle joint function excellence rate were significantly higher in group B than those of group A, and the difference was statistically significant (P<0.05), but the intraoperative blood loss, complication rate and six-month AOFAS scores in the two groups were basically the same, so there was no statistically significant difference(P>0.05). Conclusion Compared with the short tendon shift method, the periosteum shift method can hardly bring about much improvement on complications and long term ankle joint function in patients with AF combined with ITSS, but it can effectively reduce the patients' duration of surgery and postoperative recovery time, thus contributing to the improvement of patients' near term ankle joint function.