可吸收螺钉与金属螺钉治疗Maisonneuve骨折对比分析

Comparison of bioabsorbable screw and metallic screw for Maisonneuve fracture

目的比较可吸收螺钉与金属螺钉治疗踝关节Maisonneuve骨折的临床与影像学疗效。方法回顾分析2012年10月—2016年10月收治的符合选择标准的68例Maisonneuve骨折患者资料,其中37例采用金属螺钉固定下胫腓联合(A组),31例采用可吸收螺钉固定(B组)。两组患者性别、年龄、体质量、侧别、致伤原因、受伤至手术时间、合并症等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录末次随访时下胫腓间隙(tibiafibular clear space,TFCS)、下胫腓重叠(tibiafibular overlap,TFO)、内侧间隙(medial clear space,MCS)及下胫腓联合复位不良率,并记录患者踝关节跖屈和背伸活动度、疼痛视觉模拟评分(VAS)、美国矫形足踝协会(AOFAS)踝与后足评分及Olerud-Molander(OM)评分。结果两组患者均获随访,随访时间25~43个月,平均32.3个月。A、B组手术时间比较差异无统计学意义(t=1.229,P=0.282)。所有患者骨折均愈合,两组骨折愈合时间比较差异无统计学意义(t=1.367,P=0.413)。末次随访时下胫腓联合复位不良A组6例(16.2%),B组2例(6.5%),差异无统计学意义(χ^2=1.549,P=0.213)。A组有3例发生并发症,其中1例切口浅表感染,1例因未及时取出下胫腓螺钉导致断裂,1例螺钉局部异位骨化;B组有2例发生并发症,其中1例出现排斥反应,1例螺钉局部异位骨化。两组并发症发生率比较差异无统计学意义(χ^2=0.068,P=0.794)。末次随访时两组TFCS、MCS、TFO、踝关节背伸和跖屈活动度、AOFAS评分、OM评分及VAS评分比较差异均无统计学意义(P>0.05)。结论可吸收螺钉治疗Maisonneuve骨折的疗效与传统钛合金金属螺钉相似,可有效恢复踝关节功能,具有不需要二次手术取出、下胫腓联合复位不良率低的优势。

Objective To compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture.Methods The clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed.Metallic screw fixation was used in 37 cases(group A)and absorbable screw fixation was used in 31 cases(group B).There was no significant difference in age,gender,weight,operated side,cause of injury,time from injury to operation,and complications between the two groups(P>0.05).At last follow-up,the tibiafibular clear space(TFCS),tibiafibular overlap(TFO),medial clear space(MCS),and syndesmotic malreduction rate were recorded.And the dorsiflexion and plantarflexion range of motion,pain visual analogue scale(VAS)score,ankle and hind foot score of American Orthopaedic Foot and Ankle Society(AOFAS),and Olerud-Molander(OM)score were recorded.Results All patients were followed up 25-43 months,with an average of 32.3 months.There was no significant difference in the operation time between the two groups(t=1.229,P=0.282).All the fractures healed,and there was no significant difference in fracture healing time between the two groups(t=1.367,P=0.413).At last follow-up,the syndesmotic malreduction rate of group A was 16.2%(6/37),showing no significant difference when compared with group B[6.2%(2/31)](χ^2=1.549,P=0.213).There were 3 complications in group A,1 was superficial wound infection,1 was local heterotopic ossification due to failure to remove the screws in time,1 was local heterotopic ossification of the screws;and there were 2 complications in group B,1 was rejection and 1 was local heterotopic ossification of the screws.There was no significant difference in the incidence of complications between the two groups(χ2=0.068,P=0.794).There was no significant difference in TFCS,MCS,TFO,ankle dorsiflexion and plantar-flexion range of motion,AOFAS score,OM score,and VAS score between the two groups at last follow-up(P>0.05).Conclusion Compared with metallic screw,absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.