韧带修复与拉力钉固定下胫腓联合损伤的比较

Anchor suture reconstruction versus screw fixation for inferior tibiofibular syndesmosis injury

[目的]比较韧带修复与拉力钉固定治疗下胫腓联合损伤的临床疗效。[方法]2019年3月—2020年6月本院治疗伴下胫腓损伤的踝部骨折患者64例。抽签法随机将患者分为两组,32例锚钉缝线增强修复(修复组),32例拉力钉固定(固定组)。对比两组临床与影像学资料。[结果]两组患者均顺利完成手术,两组手术时间、切口长度、透视次数、术中失血量的差异均无统计学意义(P>0.05)。所有患者均获随访12个月以上,修复组恢复负重时间显著早于固定组(P<0.05)。术后随时间推移,两组伸-屈ROM及AOFAS评分均较术前显著改善(P<0.05);术后3个月修复组踝伸-屈ROM及AOFAS评分均显著优于固定组(P<0.05),但是术后6个月及末次随访时两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时两组患者TFCS和MCS均显著减少(P<0.05),而TFO显著增加(P<0.05)。相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。[结论]韧带修复与拉力钉固定均可有效治疗下胫腓损伤,但前者具有可早期负重、功能恢复更快的优点。

[Objective]To compare the clinical outcomes of anchor suture reconstruction versus screw fixation for inferior tibiofibular syndesmosis injury(ITSI).[Methods]From March 2019 to June 2020,a total of 64 patients received surgical treatment for ankle fractures accompanied with ITSI in our hospital.The patients were randomly divided into two groups by lottery,including 32 patients who underwent anchor suture reconstruction,while the other 32 patients who had screw fixation for the ITSI after fracture fixation.The clinical and imaging data of the two groups were compared.[Results]All patients had surgical procedures performed smoothly,with no significant differences in operative time,incision length,number of fluoroscopy and intraoperative blood loss between the two groups(P>0.05).All patients were followed up for more than 12 months,and the reconstruction group resumed weight-bearing activity significantly earlier than the fixation group(P<0.05).The extension-flexion ankle range of motion(ROM)and AOFAS scores in both groups improved significantly over time(P<0.05),which in the reconstruction group were significantly superior to those in the fixation group at 3 months postoperatively(P<0.05),whereas became not statistically significant between them at 6 months after operation and the latest follow-up(P>0.05).Radiographically,tibiofibular clear space(TFCS)and medial clear space(MCS)significantly decreased,while the tibiofibular overlap(TFO)significantly increased in both groups at the latest follow up compared with those preoperatively(P<0.05).However,there were no significant differences in the above imaging items between the two groups at any matching time points(P>0.05).[Conclusion]Both anchor suture reconstruction and screw fixation do effectively treat ITSI,by comparison,the former has the advantages of early weight bearing and faster functional recovery.