Maisonneuve骨折下胫腓联合损伤修复和不修复的临床疗效比较

Comparison of Clinical Effect on Surgical Treatment of Maisonneuve Fracture of the Fibula with or Without Distal Tibiofibular Syndesmosis Repair

目的 比较Maisonneuve骨折(MFF)下胫腓联合损伤时,修复与不修复下胫腓联合损伤对踝关节功能预后的影响。方法 回顾性分析2015年7月至2021年1月在郑州市骨科医院收治的54例MFF患者资料,根据是否修复MFF患者下胫腓联合损伤,分为修复组和未修复组,其中修复组29例,未修复组25例。记录并比较两组患者术前和术后1个月、术后1 a随访时踝关节正位X线片上胫腓透明间隙(TCS)、胫腓重叠距离(TOL)、内侧透明间隙(MCS)和Barid-Jackson踝关节评分;术后1个月、术后1 a随访时踝关节最大跖屈和最大背伸角度以及住院时间和住院总费用。结果 两组患者年龄、性别、受伤侧别、随访时间和平均住院时间进行比较,差异无统计学意义(P>0.05)。与术前进行比较,两组患者术后1个月和术后1 a随访时TCS和MCS降低,TOL和Barid-Jackson踝关节评分升高(P<0.05)。与未修复组患者进行比较,修复组患者在术后1个月和术后1 a随访时TCS和MCS降低,TOL升高(P<0.05)。与未修复组患者进行比较,修复组患者在术后1个月时Barid-Jackson踝关节评分、最大跖屈和背伸度数升高(P<0.05);与未修复组患者进行比较,修复组患者在术后1 a随访时,Barid-Jackson踝关节评分、最大跖屈和背伸度数升高,但差异无统计学意义(P>0.05);在住院总费用上,修复组患者高于未修复组患者(P<0.05)。结论 手术修复MFF患者下胫腓联合损伤可在早期提高患者踝关节功能,降低术后踝关节并发症的发生率,但患者总费用高。

Objective To compare the effect of repairing and not repairing the distal tibiofibular syndesmosis injury on the prognosis of ankle joint function in Maisonneuve fracture of the fibula(MFF).Methods A total of 54 patients were treated surgically in the Zhengzhou Orthopaedic Hospital for MFF from July 2015 to January 2021. According to whether to repair of the distal tibiofibular syndesmosis injury, the patients were divided into repaired group(29 cases) and unrepaired group(25 cases). At the time of preoperative, 1 month and 1 year after surgery, the tibiofibular clear space(TCS), tibiofibular overlap(TOL), medial clear space(MCS) and Barid-Jackson ankle scores were recorded and compared between the two groups. At the time of 1 month and 1 year after surgery, the maximum plantar flexion and maximum dorsal extension angle were recorded and compared between the two groups. Hospitalization stay and cost were compared between the two groups at the last follow up.Results There were no differences in the age, sex, injury side, follow-up time, preoperative TCS, TOL, MCS, Barid-Jackson ankle scores and hospitalization stay of the two groups(P>0.05). One month and 1 year after surgery, TCS and MCS were decreased, TOL and Barid-Jackson ankle scores were increased in both groups(P<0.05). Compared with the unrepaired group, the TCS and MCS were decreased, TOL were increased at 1 month and 1 year after surgery(P<0.05). Compared with the unrepaired group, the Barid-Jackson ankle score, the maximum plantar flexion and maximum dorsal extension angle were increased at 1 month after surgery in the repair group(P<0.05). Compared with the unrepaired group, the Barid-Jackson ankle score, maximum plantar flexion and maximum dorsal extension angle were increased at 1 year after surgery in the repair group, but there were no differences between the two groups(P>0.05). In terms of the total cost of hospitalization, the repaired group was higher than the unrepaired group(P<0.05).Conclusion Surgical repair of the distal tibiofibular syndesmosis injury in MFF patients can improve the early ankle function of patients and reduce postoperative ankle complications, but the cost is higher than that in the unrepaired group.