形状记忆弓齿钉与下胫腓固定螺钉治疗Maisonneuve骨折的疗效对比

Shape memory arch nail and distal tibiofibular screw in treatment of Maisonneuve fracture:a comparison of clinical efficacies

目的比较镍钛形状记忆弓齿钉和下胫腓固定螺钉治疗Maisonneuve骨折(MFF)的疗效。方法回顾性收集2019年1月至2021年12月我院收治的33例MFF患者的临床资料,根据治疗方法,将患者分为形状记忆合金弓齿钉治疗组(弓齿钉治疗组,13例)和下胫腓固定螺钉治疗组(螺钉组,20例)。比较两组患者的手术时间及术中出血量,末次随访时按照美国骨科足踝外科医师协会(AOFAS)评分标准对手术效果进行评价。结果弓齿钉治疗组和螺钉组患者的手术时间[(118.46±19.55)min vs(113.50±17.97)min]、术中出血量[(90.77±53.85)mL vs(94.50±46.53)mL]差异无统计学意义(P均>0.05)。两组患者术后切口均一期愈合,无皮肤坏死、切口感染等局部并发症。两组患者术后均随访6~24个月,平均随访时间为(14.70±5.20)个月。末次随访时,两组患者的AOFAS踝关节功能总体评估得分及踝关节症状评价得分差异均无统计学意义(P均>0.05)。结论镍钛形状记忆合金弓齿钉及下胫腓固定螺钉处理MFF中下胫腓联合损伤均能达到满意效果,但镍钛形状记忆合金弓齿钉不仅能保留踝关节及下胫腓联合的生理活动,且负重前无须常规取出,是一种值得推广的治疗方法。

Objective To compare the efficacies of nickel-titanium(NiTi)shape memory arch nail and distal tibiofibular screw in the treatment of Maisonneuve fracture(MFF).Methods The clinical data of 33 patients with MFF treated at our hospital from Jan.2019 to Dec.2021 were retrospectively collected.According to the treatment methods,the patients were divided into 2 groups:shape memory arch nail treatment group(arch nail group,13 cases)and distal tibiofibular screw treatment group(screw group,20 cases).The surgical time and intraoperative blood loss were compared between the 2 groups,and the surgical outcomes were evaluated according to the American Association of Orthopaedic Foot and Ankle Surgeons(AOFAS)scoring criteria at the last follow-up.Results There were no significant differences in the surgical time([118.46±19.55]min vs[113.50±17.97]min)or intraoperative blood loss([90.77±53.85]mL vs[94.50±46.53]mL)between the 2 groups(both P>0.05).Both groups achieved primary wound healing after surgery without local complications such as skin necrosis or wound infection.All patients in both groups were followed up for 6 to 24 months,with an average follow-up duration of(14.70±5.20)months.At the last follow-up,there were no significant differences in the overall evaluation score of ankle joint function or ankle joint symptom evaluation score of AOFAS between the 2 groups(both P>0.05).Conclusion Both NiTi shape memory arch nail and distal tibiofibular screw are effective in treating combined injuries of the distal tibiofibular joint in MFF.In addition,NiTi shape memory arch nail not only can preserve the physiological movement of the ankle joint and distal tibiofibular joint,but also requires no routine removal before weight-bearing.Therefore,it is a treatment method worthy of promotion.