袢钢板治疗踝关节骨折合并下胫腓联合分离的临床疗效

Clinical effect of loop plate in treatment of ankle joint fracture combined with distal tibiofibular syndesmosis

目的探讨袢钢板治疗踝关节骨折合并下胫腓联合分离的临床疗效。方法回顾性分析2019年5月-2021年5月行手术治疗的踝关节骨折合并下胫腓联合分离83例患者的临床资料,分为A组和B组。对两组患者的踝关节骨折均按AO治疗原则:外踝予解剖锁定钢板固定,内踝、后踝予空心螺钉固定。A组袢钢板组(观察组)用袢钢板弹性固定下胫腓联合分离;B组螺钉组(对照组)用传统普通螺钉固定下胫腓联合分离。比较两组手术相关指标,患肢部分负重时间及完全负重时间,术后1个月、3个月、6个月、12个月时踝关节的功能评分(AOFAS踝-后足评分)及术后并发症情况。结果所有患者手术均顺利完成并随访12个月以上。两组手术时间、术中出血量差异无统计学意义(P>0.05)。观察组患肢部分负重时间及完全负重时间均短于对照组,差异有统计学意义(P<0.05)。观察组在术后1个月、3个月、6个月踝关节AOFAS踝-后足评分均明显优于对照组,两组差异有统计学意义(P<0.05)。但两组在术后12个月AOFAS踝-后足评分比较差异无统计学意义(P>0.05)。观察组术后并发症发生率为7.69%,明显低于对照组的20.45%,差异有统计学意义(P<0.05)。结论使用袢钢板治疗踝关节骨折合并下胫腓联合分离较传统普通螺钉固定下胫腓联合分离,具有操作方便、可早期负重训练、利于踝关节早期康复、无断钉风险、避免二次手术等优点。袢钢板弹性固定方式是治疗下胫腓联合分离的一种有效手术方式,值得在临床工作中推广和应用。

Objective To investigate the clinical effect of loop plate in the treatment of ankle joint fracture combined with lower tibiofibular syndesmosis separation.Methods A retrospective analysis was performed on 83 patients with ankle fracture combined with lower tibiofibular syndesmosis who received surgical treatment in our hospital from May 2019 to May 2021,and they were divided into group A and group B.According to the AO treatment principle,the lateral malleolus was fixed with anatomic locking plate,and the medial malleolus and posterior malleolus were fixed with hollow screws.Group A loop plate group(observation group)was separated by loop plate elastic fixation.Group B screw group(control group)was fixed with conventional screws for distal tibiofibular syndesmosis separation.Operation-related indexes,partial and complete weight-bearing time of the affected limb,ankle functional scores(AOFAS ankleposterior foot score)and postoperative complications were compared between the two groups.Results All patients were successfully operated and followed up for more than 12 months.There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).The partial loading time and full loading time of the affected limb in the observation group were shorter than those in the control group,and the difference was statistically significant(P<0.05).Ankle AOFAS scores in the observation group were significantly better than those in the control group at 1,3 and 6 months after surgery,and the difference between the two groups was statistically significant(P<0.05).However,there was no significant difference in AOFAS ankle-posterior foot scores between the two groups 12 months after surgery(P>0.05).The incidence of postoperative complications in the observation group was 7.69%,significantly lower than that in the control group(20.45%),and the difference was statistically significant(P<0.05).Conclusion The use of loop plate in the treatment of ankle fracture combined with lower tibiofibular syndesmosis separation has the advantages of convenient operation,early weight-bearing exercise,beneficial to early ankle rehabilitation,no risk of broken nails,and avoidance of secondary surgery,compared with conventional screw fixation of lower tibiofibular syndesmosis separation.Loop plate elastic fixation is an effective surgical method for the treatment of syndesmosis of the lower tibiofibular syndesmosis,which is worthy of promotion and application in clinical practice.