缝合锚钉治疗踝关节骨折合并的下胫腓联合损伤的疗效

The curative effect of suture anchor in the treatment of ankle joint fracture with distal tibiofibular syndesmosis injury

目的探讨缝合锚钉治疗踝关节骨折合并的下胫腓联合损伤的疗效。方法回顾性分析2017年1月至2019年8月手术治疗65例合并后踝骨折的Weber C型踝关节骨折患者资料,根据治疗下胫腓联合损伤的方法分为缝合锚钉组(采用suture-anchor锚钉修复下胫腓前韧带)和螺钉固定组(采用皮质骨螺钉固定下胫腓前韧带)。缝合锚钉组17例,男7例,女10例;左11例,右6例;年龄(43.76±15.83)岁;Lauge-Hanson分型旋前外旋型10例,旋前外展型7例。螺钉固定组48例,男33例,女15例;左34例,右14例;年龄(39.90±13.57)岁;Lauge-Hanson分型旋前外旋型30例,旋前外展型18例。比较两组的手术时间、透视次数、复位质量、术后并发症、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分。结果65例患者均获得随访,随访时间(16.88±4.46)个月,术后12~16周均获骨折临床愈合。螺钉固定组手术时间和透视次数分别为(123.71±41.36)min和(25.17±16.29)次,缝合锚钉组分别为(99.94±24.16)min和(16.26±10.58)次,两组比较差异均有统计学意义(t=2.048,2.175;P=0.045,0.033)。术后螺钉固定组下胫腓联合切迹前间距和后间距分别为(3.15±1.35)mm和(6.48±1.43)mm,缝合锚钉组分别为(2.06±1.47)mm和(6.76±1.78)mm,下胫腓联合切迹前间距比较差异有统计学意义(t=3.328,P=0.002),下胫腓联合切迹后间距比较差距无统计学意义(t=0.701,P=0.486)。术后并发症发生率,螺钉固定组16.67%(8/48),缝合锚钉组5.88%(1/17),差异无统计学意义(χ^(2)=1.282,P=0.258)。AOFAS踝与后足评分优良率,16周时螺钉固定组91.67%(44/48),缝合锚钉组88.24%(15/17);末次随访时螺钉固定组95.83%(46/48),缝合锚钉组94.12%(16/17),两者差异均无统计学意义(P>0.05)。结论与螺钉固定治疗急性下胫腓联合损伤相比,缝合锚钉修复下胫腓前韧带是一种安全有效的方法,在没有增加并发症的情况下,可以增加下胫腓联合前切迹的解剖复位率,减少手术时间,但并发症发生率并未增加。

Objective To investigate the curative effect of suture anchor in the treatment of ankle joint fracture complicated with distal tibiofibular syndesmosis injury.Methods From January 2017 to August 2019,data of 65 patients with Weber C type ankle fracture combined with posterior malleolus fracture in our hospital who underwent surgical treatment were retrospectively analyzed and were divided into two groups according to the treatment method of injury:suture-anchor repair group(suture-anchor was used to repair the anterior inferior tibiofibular ligament)and screw fixation group(cortical bone screw was used to fix the tibiofibular syndesmosis).Among them,17 cases were treated with suture-anchors to repair the anterior inferior tibiafibular ligament,including 7 males,10 females,11 left and 6 right.In the Lauge-Hanson subgroup,there were 10 cases of pronation external rotation(PER),and 7 cases of pronation abduction(PA).The mean age was 43.76±15.83 years old.Forty-eight patients were treated with cortical screw fixation,including 33 males,15 females,34 left and 14 right.In the Lauge-Hanson subgroup,there were 30 cases of PER,and 18 cases of PA.The mean age was 39.90±13.57 years old.The differences in operation time,number of fluoroscopy,quality of reduction and postoperative complications were compared between the two groups.The ankle joint function was compared at 16 weeks postoperatively and at the last follow-up.The ankle joint function score was based on the American Orthopaedic Foot and Ankle Society(AOFAS)hindfoot score.Results All the 65 patients were followed up and the average follow-up time of 65 cases was 16.88±4.46 months.All the fractures were clinically healed 12-16 weeks after operation.The operative time of screw fixation group was 123.71±41.36 min,and the number of fluoroscopy was 25.17±16.29 times,while the operative time of suture-anchor repair group was 99.94±24.16 min and the number of fluoroscopy was 16.26±10.58 times.The difference between the two groups was statistically significant(t=2.048,2.175;P=0.045,0.033).In the screw fixation group,the mean anterior and posterior distance of the tibiofibular syndesmosis was 3.15±1.35 mm,and 6.48±1.43 mm,respectively.In the suture-anchor repair group,the mean anterior distance of the syndesmosis was 2.06±1.47 mm,and the mean posterior distance of the syndesmosis was 6.76±1.78 mm.There was statistically significant difference in the distance of anterior distance of the syndesmosis(t=3.328,P=0.002),while there was no statistically significant difference in the posterior distance of the syndesmosis(t=0.701,P=0.486).The incidence of postoperative complications was 16.67%(8/48)in the screw fixation group and 5.88%(1/17)in the suture-anchor repair group,which was no statistically different(χ^(2)=1.282,P=0.258).The excellent and good rates of AOFAS ankle-hindfoot scores were 91.67%(44/48)in the screw fixation group and 88.24%(15/17)in the suture-anchor repair group at 16 weeks;95.83%(46/48)in the screw fixation group and 94.12%(16/17)in the suture-anchor repair group at the last follow-up.There was no significant difference(P>0.05).Conclusion Compare with screw fixation in the treatment of acute distal tibiofibular syndesmosis injury,suture-anchor repair of anterior inferior tibiofibular ligament is a safe and effective method.It can increase the anatomical reduction rate of anterior distance of the syndesmosis,and reduce the operation time without increasing the incidence of complications.