缝合锚钉技术治疗下胫腓联合损伤的临床疗效

Effect of suture anchor technology in treatment of patients with distal tibiofibular syndesmosis injury

目的 探讨缝合锚钉固定治疗下胫腓联合损伤的手术方法及临床疗效。方法 选取下胫腓联合损伤患者63例,其中缝合锚钉组患者34例,金属螺钉组患者29例。所有患者结合病史、查体及影像学检查进行诊断,按照踝关节骨折(Lauge-Hansen)分型进行手术治疗;X线、CT测量评价下胫腓联合损伤及修复情况;采用美国足踝外科协会(AOFAS)评分标准评价临床疗效。结果 获得随访患者共58例,缝合锚钉组30例随访时间平均24个月(13~42个月);金属螺钉组28例随访时间平均25个月(15~42个月)。所有患者未出现术后切口感染、内固定松动断裂以及下胫腓联合固定失效等并发症。X线及CT测量显示,2组患者下胫腓联合损伤与术前比较均有显著改善,2组术后AOFAS评分差异具有统计学意义(P<0.05)。结论 缝合锚钉固定下胫腓联合符合弹性固定,可避免二次手术取出。精细的手术操作技术和下胫腓联合解剖可让患者获得良好的踝关节功能恢复,缝合锚钉固定是治疗下胫腓韧带联合损伤的有效方法之一。

Objective To investigate the surgical method and clinical effect of suture anchor fixation in the treatment of patients with distal tibiofibular syndesmosis injury. Methods A total of 63 patients with distal tibiofibular syndesmosis injury were selected and divided into suture anchor group(n=34) and metal screw group(n=29). All the patients were diagnosed based on medical history, physical examination and imaging examination, and surgical treatment was performed according to the classification of ankle fracture(Lauge-Hansen);X-ray and CT measurements were used to evaluate the impaired and repair conditions of lower tibiofibular syndesmosis injury;clinical efficacy was evaluated by the American Orthopedic Foot & Ankle Society(AOFAS). Results A total of 58 patients were followed up, 30 patients in the conventional suture anchor group were followed up for 24 months(13~42 months), and 28 patients in the metal screw group were followed up for 25 months(15~42 months). No complications such as postoperative incision infection, loose and broken of internal fixation, and failure of fixation of lower tibiofibular syndesmosis were observed in all the patients. X-ray and CT measurement showed that the lower tibiofibular syndesmosis injury in both groups improved significantly when compared with that before operation, and the difference of AOFAS score between the two groups was statistically significant(P<0.05). Conclusion Suture anchor fixation of lower tibiofibular syndesmosis conforms to standard of elastic fixation, which can avoid removal of secondary operation. Fine surgical techniques and anatomy of lower tibiofibular syndesmosis enable patients to obtain good ankle function recovery, and suture anchor fixation is one of the effective methods for treatment of lower tibiofibular syndesmosis injury.