伴有踝关节骨折的亚急性下胫腓损伤手术治疗的中期疗效分析

Mid-term effects of surgery for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture

目的探讨伴有踝关节骨折的亚急性下胫腓损伤手术治疗的中期疗效。方法回顾性分析2014年7月至2019年10月上海交通大学附属第六人民医院骨科-足踝外科手术治疗的14例伴有踝关节骨折的亚急性下胫腓损伤患者资料。男11例,女3例;年龄17~61岁,平均35.9岁;Danis-Weber分型:B型6例,C型8例;Lauge-Hansen分型:旋后外旋型7例,旋前外展型1例,旋前外旋型6例(4例为Maisonneuve骨折)。下胫腓处理方式如下:下胫腓螺钉固定11例,Tightrope弹性固定1例,下胫腓螺钉联合Tightrope混合固定1例,下胫腓融合1例。术后观察并发症,比较患者术前及末次随访时疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)的踝-后足评分。结果14例患者术后随访24~85个月(平均46.8个月)。9例(包括1例混合固定)取出下胫腓螺钉(1例取出所有内固定手术后伤口感染,2例出现下胫腓分离,5例踝关节退变,1例出现腓骨骨不连)。3例患者未取出下胫腓螺钉(2例螺钉断裂,1例螺钉松动,1例下胫腓分离)。VAS评分从术前(6.8±0.9)分降至末次随访时(1.4±1.3)分,AOFAS的踝-后足评分从术前(35.3±6.3)分提高至末次随访时(86.8±11.7)分,差异均有统计学意义(P<0.001)。AOFAS的踝-后足评价:优8例,良4例,可2例。结论伴有踝关节骨折的亚急性下胫腓损伤手术重新稳定下胫腓和踝关节,中期疗效良好,疼痛和踝关节功能改善明显。

Objective To evaluate the mid-term efficacy of surgery for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture.Methods From July 2014 to October 2019,14 patients were treated at Foot&Ankle Section,Department of Orthopaedics,Shanghai Sixth People’s Hospital for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture.There were 11 males and 3 females,aged from 17 to 61 years(mean,35.9 years).According to Danis-Weber classification,6 cases were type B and 8 type C;according to Lauge-Hansen classification,7 cases belonged to supination-external rotation,one to pronation-abduction,and 6 to pronation-external rotation(Maisonneuve fracture in 4).The syndesmosis injury was treated by fixation with distal tibiofibular screws in 11 cases,by Tightrope elastic fixation in one,by hybrid fixation with distal tibiofibular screws and Tightrope in one,and by distal tibiofibular fusion in one.Postoperative complications were recorded.Their visual analogue scale(VAS)and American Orthopaedic Foot and Ankle Society ankle-hindfoot scores(AOFAS-AH)were compared between preoperation and the last follow-up.Results The 14 patients were followed up for 24 to 85 months(mean,46.8 months).Of the 9 patients whose distal tibiofibular screws had been removed(including one with hybrid fixation),wound infection occurred in one after removal of all the internal fixation,distal tibiofibular widening in 2,ankle degeneration in 5 and fibular nonunion in one.Of the other 3 patients whose distal tibiofibular screws had not been removed,screw breakage happened in 2,screw loosening in one and distal tibiofibular widening in one.The VAS scores were significantly improved from preoperative 6.8±0.9 to 1.4±1.3 at the last follow-up;the AOFAS-AH scores were increased significantly from preoperative 35.3±6.3 to 86.8±11.7 at the last follow-up(both P<0.001).According to AOFAS-AH scores,8 cases were excellent,4 good and 2 moderate.Conclusion Surgery for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture can restabilize the distal tibiofibular syndesmosis and ankle joint,reduce pain and improve ankle function,leading to fine mid-term efficacy.