带袢钢板治疗下胫腓联合分离的疗效分析

Analysis of curative effect of the treatment of inferior tibiofibular joint separationwith loop plate

目的 观察应用带袢微型钢板治疗踝关节骨折合并下胫腓关节分离的临床疗效。方法 对2017年5月-2021年3月就诊于荆州市第三人民医院因创伤导致踝关节骨折合并下胫腓联合分离的36例患者随机分成观察组和对照组,每组18例,观察组采用带袢微型钢板弹性固定的方法治疗,对照组采用踝穴上横行螺钉固定的方法治疗。对比分析两组治疗后的部分及完全负重时间、踝关节活动度、胫骨前结节与腓骨重叠影(TFO)、下胫腓联合间隙(TFCS)、踝关节功能评分(AOFAS)及并发症发生情况。结果 术后36例均获得随访,随访时间2~18个月,平均(12.1±2.3)个月。骨折均顺利一期愈合,两组术后均未发生伤口感染、皮肤坏死、深静脉血栓形成等并发症。对照组术后8周内出现固定断裂1例,取出螺钉后下胫腓联合再分离1例。观察组的部分负重及完全负重时间均短于对照组,观察组踝关节背伸、跖屈活动度和AOFAS评分大于对照组,两组的差异有统计学意义(P <0.05)。两组术后踝关节的TFO及TFCS差异均无统计学意义(P>0.05)。结论 带袢微型钢板治疗下胫腓联合分离恢复了下胫腓联合的正常功能,符合生理特点,术后早负重,减少恢复时间,可以早期功能训练,不需早期取出内固定,无内固定断裂,并发症少,获得较好的临床疗效,是一种安全、可靠、有效的治疗方法。

Objective To observe the clinical effect of ankle fracture combined with inferior tibiofibular joint separation with loop micro button plate.Methods From May 2017 to March 2021,36 patients with ankle joint fracture combined with tibiofibular syndesmosis separation caused by trauma in Jingzhou Third People's Hospital were randomly divided into the study group and the control group,with 18 cases in each group.The study group was treated by elastic fixation of micro-plate with loop.The control group was treated with transverse screw fixation at the ankle point.The partial and complete weight bearing time,ankle range of motion,overlap between anterior tibial nodule and fibula(TFO),tibiofibular joint space(TFCS),ankle function score(AOFAS)and complications were compared between two groups after treatment.Results All 36 patients were followed up for 2~18 months,with an average of(12.1±2.3)months.The fractures healed smoothly in one stage,and there were no complications such as wound infection,skin necrosis and deep vein thrombosis in two groups.In the control group,1 case had fixation fracture within 8 weeks after operation,and 1 case had tibiofibular syndesmosis re-separation after removing the screw.The time of partial and complete weight bearing in the study group was shorter than that in the control group,and the ankle dorsiflexion,plantar flexion range of motion and AOFAS score in the study group were greater than those in the control group,and the differences between two groups were statistically significant(P<0.05).There was no significant dference in TFO and TFCS between two groups(P>0.05).Conclusion The treatment of the separation of the inferior tibiofibular syndesmosis with a loop button plate is consistent with physiological characteristics,early postoperative weight bearing,reduced recovery time,early functional exercise,no early removal of internal fixation,no internal fixation fracture,fewer complications and other advantages.It is a safe,reliable and effective treatment to obtain better clinical efficacy.