下胫腓联合螺钉内固定治疗急性踝关节骨折伴三角韧带损伤的效果观察

Effect observation of distal tibiofibular syndesmosis screw fixation in treatment of acute ankle fracture complicated with deltoid ligament injury

目的观察下胫腓联合螺钉内固定对急性踝关节骨折伴三角韧带损伤患者术后关节功能恢复的影响。方法将138例急性踝关节骨折伴三角韧带损伤患者随机分为对照组(n=66)和观察组(n=72),对照组采取三角韧带修复,观察组采取下胫腓联合螺钉内固定术治疗。比较2组患者手术时间和术后骨折愈合时间、术后并发症、末次随访时踝关节功能以及影像学测量指标水平。结果2组患者性别、年龄、受伤至就诊时间以及受伤类型等临床资料比较,差异均无统计学意义(P>0.05)。2组患者手术时间以及术后骨折愈合时间比较,差异无统计学意义(P>0.05)。末次随访时,2组患者踝关节功能评分以及影像学测量指标水平比较,差异均无统计学意义(P>0.05)。所有患者术后均未出现感染,对照组患者均未发生不良反应,观察组有1例患者因位置不佳行二次手术治疗,1例患者发生螺钉断裂。结论急性踝关节骨折伴三角韧带损伤患者采取三角韧带修复或下胫腓联合螺钉内固定疗效相当,但下胫腓联合螺钉内固定的复位不良率更高,存在术后断钉风险,而三角韧带修复手术需要注意的细节较多。

Objective To observe the effect of distal tibiofibular syndesmosis screw fixation on postoperative recovery of joint function in patients with acute ankle fracture complicated with deltoid ligament injury.Methods A total of 138 patients with acute ankle fracture complicated with deltoid ligament injury were randomly divided into control group(n=66)and observation group(n=72).The control group was treated with deltoid ligament repair,while the observation group was treated with distal tibiofibular syndesmosis screw fixation.The operation time,postoperative fracture healing time,postoperative complications,ankle function at the last follow-up and imaging measurement indexes were compared between the two groups.Results There were no significant differences in gender,age,injury to visit time and type of injury between the two groups(P>0.05).There were no significant differences in operation time and postoperative fracture healing time between the two groups(P>0.05).At the last follow-up,there were no significant differences in ankle function score and imaging measurement indexes between the two groups(P>0.05).No infection occurred in all the patients after operation,and no adverse reactions occurred in the control group.In the observation group,one patient underwent secondary operation due to poor position,and one patient suffered from screw fracture.Conclusion For patients with acute ankle fracture complicated with deltoid ligament injury,tibiofibular syndesmosis screw internal fixation can obtain the same effect as deltoid ligament repair,but the rate of poor reduction is relatively higher,and there is a risk of postoperative nail breakage.Deltoid ligament repair surgery needs more attention in details.