手术治疗踝关节骨折合并下胫腓联合损伤

Surgical treatment of malleolar fracture combined with distal tibiofibular syndesmosis injuries

目的探讨手术治疗踝关节骨折合并下胫腓联合损伤的疗效。方法将49例伴有下胫腓联合损伤的踝关节骨折患者依据手术方法不同分为下胫腓置钉组(23例)和下胫腓未置钉组(26例)。术后采用AOFAS踝-后足评分系统评价踝关节功能,测量踝关节背伸和跖屈角度。结果患者均获得随访,时间12~18个月。术后1、3个月踝关节功能优良率两组比较差异均有统计学意义(P<0.05),术后6个月两组比较差异无统计学意义(P>0.05)。末次随访时踝关节跖屈、背伸角度两组比较差异均无统计学意义(P>0.05)。结论手术治疗合并下胫腓联合损伤的踝关节骨折,部分病例可以免除下胫腓螺钉固定,支持早期功能锻炼,可获得良好的疗效。

Objective To investigate the therapeutic effects of surgery treatment for malleolar fractures combined with distal tibiofibular syndesmosis injuries.Methods Forty-nine cases of malleolar fractures with distal tibiofibular syndesmosis injuries were divided into two groups:distal syndesmotic screw fixation group(23 cases)and distal non-syndesmotic screw fixation group(26 cases).The ankle function was evaluated by the AOFAS ankle-hindfoot scoring system,and the angles of dorsal extension and plantar flexion of the ankle joint were measured.Results All patients were followed up for 12~18 months.At 1,3 months after surgery,there were statistically significant differences in the excellent-good rate of ankle function between the two groups(P<0.05),while there was no statistically significant difference between two groups at 6 months postoperation(P>0.05).At last follow-up,there were no significant differences in the angles of dorsal extension and plantar flexion of the ankle joint between the two groups(P>0.05).Conclusions In the treatment of ankle fracture combined with distal tibiofibular syndesmosis injuries,surgery treatment can avoid the distal syndesmotic in some patients,and surpport the patient to do early excise,and which can gain good effect.