TightRope带袢钢板治疗踝关节骨折合并下胫腓联合损伤的临床研究

Clinical study on TightRope plate with loop in the treatment of patients with ankle fracture combined with syndesmosis injury

目的探讨TightRope带袢钢板治疗踝关节骨折合并下胫腓联合损伤及对骨代谢、踝关节功能的影响。方法成都骨科医院收治的85例踝关节骨折合并下胫腓联合损伤患者,采用随机数表法分为观察组(n=43)与对照组(n=42)。对照组给予内固定治疗,观察组给予TightRope带袢钢板治疗。比较两组骨代谢指标、踝关节Kofoed评分、美国足踝外科协会(AOFAS)评分、下胫腓重叠距离(TBOL)和下胫腓间隙(TBCS)变化情况及并发症。结果观察组手术时间长于对照组,住院时间、骨折愈合时间低于对照组(P<0.05);术后两组骨碱性磷酸酶(BALP)、骨钙素(BGP)均升高,β-CTX均降低,观察组改善程度优于对照组(P<0.05);两组Kofoed、AOFAS评分均较术前升高,且观察组评分高于对照组(P<0.05);两组TBOL较术前升高,TBCS降低,两组间比较差异无统计学意义(P>0.05);两组不良反应主要为愈合不良、活动障碍及踝关节肿胀,差异无统计学意义(P>0.05)。结论TightRope带袢钢板治疗踝关节骨折合并下胫腓联合损伤有一定效果,可有效改善骨代谢、踝关节功能。

Objective To investigate the efficacy of TightRope belt loop plate in the treatment of patients with ankle fracture combined with hypotibiofibular syndesmosis injury and its effect on bone metabolism and ankle function.Methods Eighty-five patients with ankle fracture combined with tibiofibular syndesmosis injury in Chengdu Orthopedic Hospital were randomly divided into an observation group(n=43)and a control group(n=42).The control group was treated with internal fixation,while the observation group was treated with TightRope plate with loop.Bone metabolic indexes,ankle Kofoed score,American Foot and Ankle Surgery Society(AOFAS)score,and changes in tibiofibular overlap(TBO)and tibiofibular bottom clearance(TBCS)as well as complications were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,and the hospital stay and fracture healing time of the observation group were shorter than those of the control group(P<0.05).After operation,bone-type alkaline phosphatase(BALP)and osteocalcin(BGP)were increased,andβ-specific sequence(β-CTX)was decreased in both groups and the improvement degree of the observation group was better than that of the control group(P<0.05).After operation,the Kofoed and AOFAS scores of the two groups were increased,and the observation group was higher than the control group(P<0.05).After operation,TBO was increased and TBCS was decreased in both groups,and there was no difference between the two groups(P>0.05).The main adverse reactions in the two groups were poor healing,mobility disorder and ankle swelling and there was no significant difference in the adverse reaction between the two groups(P>0.05).Conclusions TightRope loop plate has a certain effect in the treatment of ankle fracture combined with tibiofibular syndesmosis injury.It can effectively improve the bone metabolism and the ankle function.