下胫腓联合螺钉固定术后异位骨化形成及原因分析

Heterotopic Ossification after Syndesmotic Screw Fixation for Syndesmosis Injury in Malleolar Fracture

目的:探讨踝关节骨折下胫腓联合损伤下胫腓联合螺钉固定术后异位骨化的发生率及形成因素。方法:回顾性分析2016年1月-2019年10月因踝关节骨折伴下胫腓联合损伤在东莞市第八人民医院骨科住院手术治疗的患者共48例,应用X线片评估术后异位骨化形成情况,并应用CT评估术后下胫腓联合复位情况,对性别、年龄、骨折AO-Denis-Weber分型、有无下胫腓前后軔带撕脱性骨块、术后下胫腓联合复位情况等因素进行多因素Logistic回归分析。结果:48例患者中11例发生下胫腓联合处异位骨化,发生率22.92%。多因素Logistic回归分析发现术后下胫腓联合异位骨化形成的主要因素为下胫腓联合复位不良。结论:下胫腓联合损伤后,下胫腓联合复位不良加上螺钉刚性固定是下胫腓联合异位骨化形成的主要因素。

Objective:The purpose of this study was to report the incidence and clinical relevance of HO after syndesmotic screw fixation in syndesmosis injury.Methods:A retrospective analysis and review of the radiographic images of 48 malleolar fractures was performed between 1.2016 and 10.2019.All patients underwent open reduction and internal fixation(ORIF)for malleolar fractures,and syndesmotic screw fixation was accomplished for syndesmosis injury.The mean follow-up was 6 months,and some patients were followed fori year.The development of HO and the quality of syndesmosis reduction were recorded.Results:In all 48 cases,11 patients had HO,and all 11 patients had evidence of syndesmosis malreduction,and in another 37 patients without HO,7 showed poor reduction of syndesmosis(P<0.05).Conclusion:Malreduction with static fixation of tibiofibular syndesmosis might be the predominant reason for HO.The static fixation made the syndesmosis injury to exist constantly,this might be the main factor.