TightRope带袢钢板与皮质骨螺钉内固定治疗踝关节骨折合并的下胫腓联合损伤疗效比较

Comparative study between TightRope and cortical bone screw fixation for ankle fractures with distal tibiofibular syndesmosis injuries

目的比较采用TightRope带袢钢板与皮质骨螺钉内固定治疗踝关节骨折合并的下胫腓联合损伤的临床效果。方法回顾性分析自2017-02—2019-04采用切开复位内固定治疗的66例踝关节骨折合并下胫腓联合损伤,其中36例下胫腓联合采用TightRope带袢钢板内固定(带袢钢板组),30例下胫腓联合采用皮质骨螺钉内固定(螺钉组)。比较两组术后至开始完全负重时间、术后踝与后足功能AOFAS评分、术后踝关节正位X线片测量的下胫腓间隙及下胫腓重叠。结果 66例均获得随访,随访时间平均14.2(12~18)个月。所有患者踝关节骨折均获得愈合,下胫腓联合均完全复位。带袢钢板组术后至开始完全负重时间较螺钉组短,术后6个月踝与后足功能AOFAS评分高于螺钉组,差异有统计学意义(P<0.05)。带袢钢板组与螺钉组术后3个月、12个月踝与后足功能AOFAS评分差异无统计学意义(P>0.05)。带袢钢板组与螺钉组术后第3天、3个月、6个月、12个月踝关节正位X线片测量的下胫腓间隙及下胫腓重叠数值差异无统计学意义(P>0.05)。结论踝关节骨折合并下胫腓联合损伤切开复位内固定术中采用TightRope带袢钢板与皮质骨螺钉均可有效固定下胫腓联合,而带袢钢板在获得与皮质骨螺钉相同固定强度的同时还能维持下胫腓联合微动关节的特性,使患者能够早期下床负重活动,缩短了康复时间。

Objective To compare the clinical and imaging effects of TightRope and screw fixation for ankle fractures with dis-tal tibiofibular syndesmosis injuries.Methods A retrospective analysis was performed on 66 cases of ankle fractures with tib-iofibular syndesmosis injuries treated with open reduction and internal fixation from February 2017 to April 2019, 36 cases oftibiofibular syndesmosis injuries were treated with Tight Rope fixation(Tight Rope group), and 30 cases of tibiofibular syndesmo-sis injury were treated with cortical bone screw fixation(screw group). The time to complete weight bearing after operation(bur-den time), postoperative AOFAS score of ankle and hind foot function, the tibiofibular space and inferior tibiofibular overlapmeasured by orthographic X-ray of ankle joint were compared between the two groups.Results Sixty-six cases were followedup for an average of 14.2(12-18) months. All the ankle fractures were healed and the distal tibiofibular syndesmosis was com-pletely reduced. The burden time of the Tight Rope group was shorter than that of the screw group, and the AOFAS score of an-kle and hind foot function at 6 months after surgery of the Tight Rope group were higher than those of the screw group, the differ-ence between the two groups was statistically significant(P<0.05). There was no significant difference in AOFAS score of ankleand hind foot function between the Tight Rope group and the screw group at 3 and 12 months after surgery(P>0.05). There wereno significant differences in the values of tibiofibular space and tibiofibular overlap between the Tight Rope group and the screwgroup on the 3 rd day, 3 months, 6 months and 12 months after surgery(P>0.05).Conclusion In the open reduction and inter-nal fixation of ankle fractures with distal tibiofibular syndesmosis injuries, both Tight Rope and cortical bone screw can fix effec-tively. Fixation strength of Tight Rope was the same as cortical bone screw, but Tight Rope fixation can maintain the micromotioncharacteristics of the distal tibiofibular syndesmosis, enable patients to do weight-bearing activities earlier and shorten recoverytime.