改良法置钉对合并下胫腓联合分离的踝关节骨折治疗效果

The Efficacy of Implanting Screws Using Improved Methods on Ankle Fractures Associated with Distal Tibiofibular Syndesmosis Separation

目的观察改良法置钉对合并下胫腓联合分离的踝关节骨折治疗效果,方法回顾性选取2018年6月至2020年5月广州医科大学附属第六医院骨科二区治疗的50例合并单侧下胫腓联合分离的踝关节骨折患者作为研究对象,按照置入下胫腓螺钉方法不同分成A组25例(传统手术组)和B组25例(改良法置钉组),比较两组平均手术时间、术中置入下胫腓联合螺钉时透视的次数、术后踝关节CT评估下胫腓联合复位质量以及下胫腓联合螺钉的位置、术后1年采用Baird-Jackson评分评价踝关节的功能。结果B组手术时间(70.23±11.22)min短于A组(80.12±12.33)min,具有统计学差异(P<0.05);置入下胫腓联合螺钉时B组透视次数(3.5±1.2)少于A组(6.1±1.6)次,具有统计学差异(P<0.05);下胫腓联合复位质量B组好于比A组,具有统计学差异(P<0.05);下胫腓联合螺钉位置B组优良率好于A组,具有统计学差异(P<0.05),术后1年踝关节Baird-Jackson评分B组踝关节功能好于A组,具有统计学差异(P<0.05)。结论参照健侧腓骨角平分线法置入患侧下胫腓联合螺钉,使术中放射次数少,下胫腓联合复位及固定及踝关节功能满意,是一种简便有效的置钉方法。

Objective To observe the effect of implanting screws using improved methods on ankle fractures associated with distal tibiofibular syndesmosis separation.Methods 50 patients with ankle fractures associated with distal tibiofibular syndesmosis separation were admitted to the Sixth Hospital of Guangzhou Medical University during June 2018 to May 2020,which were retrospectively divided into 25 cases in group A(traditional surgical group)and 25 cases in group B(modified screw placement group)according to different treatment methods of inserting distal tibiofibular screw.The operative time and intraoperative fluoroscopy times of inserting tibiofibular syndesmosis screw were compared between the two groups,the CT scan were used to evaluate the quality of tibiofibular syndesmosis reduction and the position of the lower tibiofibular syndesmosis screw,and Baird-Jackson scoring system were used to compare ankle function one year after surgery.Results The average operation time in group B was(70.23±11.22)min,which was shorter than that in group A(80.12±12.33)minutes,which was statistically significant(P<0.05).The average intraoperative fluoroscopy times of inserting tibiofibular syndesmosis screw in group B was(3.5±1.2)times less than that in group A(6.1±1.6)times,which was statistically significant(P<0.05);The postoperative reduction quality of lower tibiofibular syndesmosis in group B was better than that in group A,which was statistically significant(P<0.05);The excellent and good rate of inferior tibiofibular joint screw position in group B was better than that in group A,which was statistically significant(P<0.05).One year of operation,the efficacy was evaluated according to the Baird ankle scoring system Ankle function score in group B was better than that in group A,which was statistically significant(P<0.05).Conclusions Considering the angle of the fibular cortex,inserting the lower tibiofibular syndesmosis screw is a simple and effective work,less intraoperative radiation,satisfactory reduction,fixation of the lower tibiofibular syndesmosis and satisfactory ankle function are required.