切开复位联合钢板弹性固定治疗陈旧性踝关节骨折并下胫腓联合损伤的效果研究

Curative Effect of Open Reduction Combined with Plate Flexible Fixation on Old Ankles Fracture Combined with Distal Tibiofibular Syndesmosis Injuries

目的 研究切开复位联合钢板弹性固定治疗陈旧性踝关节骨折并下胫腓联合损伤(ankles fracture combined with distal tibiofibular syndesmosis injuries, AFTSI)的效果。方法 便利收集2018年5月—2021年1月福建医科大学附属南平第一医院骨关节科收治的60例陈旧性AFTSI患者的临床资料进行分析,根据手术方法分为A组(32例,切开复位联合Tightrope袢钢板系统弹性固定治疗)和B组(28例,切开复位联合螺钉固定治疗),比较两组患者围术期指标、踝关节活动度、下胫腓联合损伤情况、疼痛情况、关节功能及并发症发生情况。结果A组患者的部分负重时间及完全负重时间(4.03±0.72)、(8.79±1.26)周均短于B组的(5.29±0.87)、(12.08±1.74)周,差异有统计学意义(t=6.137、8.461,P<0.05);术后6个月,A组患者的背伸、跖屈角度(16.72±3.84)、(33.92±6.49)°均大于B组的(13.49±3.27)、(27.18±5.03)°,差异有统计学意义(t=3.480、4.448,P<0.05);术后6个月,A组患者的视觉模拟评分(VAS)(2.26±0.34)分低于B组的(3.63±0.78)分、美国足踝外科学会踝-后足评分(AOFAS)为(67.29±7.30)分高于B组的(59.15±6.38)分,差异有统计学意义(t=9.013、4.567,P<0.05)。结论 切开复位联合Tightrope袢钢板弹性固定治疗陈旧性AFTSI效果良好,可促使患者尽早进行功能锻炼,促进关节活动度及功能早期改善,值得临床参考。

Objective To study the curative effect of open reduction combined with plate flexible fixation on old ankles fracture combined with distal tibiofibular syndesmosis injuries(AFTSI). Methods Clinical data of 60 AFTSI patients admitted to orthopedics Department of Nanping First Hospital Affiliated to Fujian Medical University from May 2018 to January 2021 were conveniently collected for analysis. According to the surgical method, they were divided into group A(32 patients, open reduction combined with Tightrope loop plate system elastic fixation) and group B(28 patients, open reduction combined with screw fixation). The perioperative indexes, ankle range of motion, occurrence of distal tibiofibular syndesmosis injuries, pain, joint function and complications were compared between the two groups.Results The partial weight-bearing time and full weight-bearing time in group A were(4.03±0.72) weeks and(8.79±1.26) weeks, shorter than those in group B [(5.29±0.87) weeks,(12.08±1.74) weeks], and the difference was statistically significant(t=6.137, 8.461, P<0.05);at 6 months after surgery, dorsiflexion and plantar flexion angles in group A were(16.72±3.84)° and(33.92±6.49)°, greater than those in group B [(13.49±3.27)°,(27.18±5.03)°], and the difference was statistically significant(t=3.480, 4.448, P<0.05);at 6 months after surgery, score of Visual Analogue Scale(VAS)(2.26±0.34) points in group A was lower than that in group B(3.63±0.78) points, while score of American Orthopedic Foot and Ankle Society(AOFAS)(67.29±7.30) points was higher than that in group B(59.15±6.38) points, and the difference was statistically significant(t=9.013, 4.567, P<0.05). Conclusion Curative effect of open reduction combined with Tightrope loop plate flexible fixation is good on old AFTSI, which can promote early functional exercise,early improvement of joint range of motion and function.