Endobutton钢板与单枚下胫腓螺钉在急性下胫腓联合损伤中的疗效比较

Curative Effect of the Usage of Endobutton and Single Syndesmotic Screw in Acute Inferior Tibiofibular Combined Injury

目的比较Endobutton带袢钢板与单枚下胫腓螺钉治疗急性下胫腓联合损伤的临床疗效,从而指导临床实践。方法回顾性队列研究51例伴踝关节骨折的急性下胫腓联合损伤的病例,其中26例患者行单枚4.5mm全螺纹螺钉治疗(A组),25例患者行Endobutton带袢钢板固定(B组)。对两组患者术后12周、24周、48周进行AOFAS评分、OMA评分、VAS疼痛评分及测量X线/CT下胫腓前、中、后间隙,并对测量结果进行比较统计学分析。结果术后84周B组AOFAS评分高于A组,且其差异具有统计学意义(P<0.01)。B组的OMA评分自术后24周均高于A组,且两者之间的差异具有统计学意义(P<0.01);B组行走时VAS疼痛评分均低于A组,B组日常活动中VAS疼痛评分在术后24周及48周均低于A组,差异有统计学意义(P=0.007)。而A组及B组在夜间、休息时VAS疼痛评分差异无统计学意义(P>0.05)。术后48周时随访CT扫描结果所示:患侧与健侧的下胫腓距离差异,A组在下胫腓前间隙(A点)、下胫腓中间间隙(B点)距离差异较B组大(P=0.01、P=0.03)。结论使用Endobutton带袢钢板治疗急性下胫腓联合损伤较单纯下胫腓螺钉固定可以获得更好的临床疗效,并且达到更好的下胫腓关节愈合。

Objective To investigate the clinical efficacy of Endobutton and single Syndesmotic Screw in the treatment of acute inferior tibiofibular combined injury,so as to guide clinical practice.Methods A retrospective cohort study was conducted on 51 cases of an ankle injury that included the syndesmosis,of which 26 were treated with A single 4.5 mm screw(group A)and 25 were fixed with an Endobutton(group B).AOFAS score,OMA score,VAS pain score and measurement of the anterior,middle and posterior tibiofibular space of the lower tibiofibular region of X ray/CT were performed at 12,24 and 48 weeks after surgery in the two groups of patients,and the measurement results were compared and statistically analyzed.Results AOFAS score of group B was higher than that of group A at 24 weeks after operation,and the difference was statistically significant(P<0.01).The OMA score of group B was higher than that of group A at 24 weeks after surgery,and the difference between the two groups was statistically significant.VAS pain score in group B was lower than that in group A when walking,and VAS pain score in group B in daily activities was lower than that in group A at 24 weeks and 48 weeks after surgery,showing statistical differences.There was no significant difference in VAS pain score between group A and group B at night or at rest.CT scan results of follow-up at 48 weeks after surgery showed that the distance between the affected side and the healthy side was different,and the distance between the lower tibiofibular space(point A)and the middle tibiofibular space(point B)in group A was larger than that in group B.Conclusion Endobutton can achieve better clinical effect and better healing of acute syndesmosis injury than single Syndesmotic Screw.