下胫腓螺钉固定联合下胫腓韧带修复治疗踝关节骨折伴下胫腓联合损伤的临床效果

Clinical Effect of Lower Tibiofibular Screw Fixation Combined with Lower Tibiofibular Ligament Repair in the Treatment of Ankle Joint Fracture Combined with Lower Tibiofibular Syndesmosis Injury

目的:探讨踝关节骨折伴下胫腓联合损伤患者给予下胫腓螺钉固定与下胫腓韧带修复联合治疗的临床效果。方法:选取2022年1月—2023年1月顺昌县医院骨外科收治的86例踝关节骨折伴下胫腓联合损伤患者作为研究对象,以随机数表法分为对照组(43例)与研究组(43例),对照组给予下胫腓螺钉固定治疗,研究组在对照组基础上给予下胫腓韧带修复治疗,比较两组围手术期指标、疼痛程度、踝关节活动度、踝关节功能及并发症。结果:较对照组,研究组术中出血量更多,手术时间更长,差异有统计学意义(P<0.05);但两组住院时间比较,差异无统计学意义(P>0.05)。术后3个月、6个月,两组疼痛程度数字评分法(numeric rating scale,NRS)评分较术前降低,且研究组低于对照组,差异有统计学意义(P<0.05);术后6个月,两组踝关节跖屈、背伸活动度较术前增大,且研究组大于对照组,差异有统计学意义(P<0.05);术后6个月,两组Baird-Jackson评分、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分系统评分较术前升高,且研究组高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率(2.33%)较对照组(18.60%)更低,差异有统计学意义(P<0.05)。结论:下胫腓螺钉固定与下胫腓韧带修复联合治疗踝关节骨折伴下胫腓联合损伤患者,虽会导致术中出血量增加及手术时间延长,但能降低患者疼痛程度,促进踝关节活动度改善,改善踝关节功能,降低并发症发生率。

Objective:To explore the clinical effect of lower tibiofibular screw fixation combined with lower tibiofibular ligament repair in patients with ankle joint fracture and lower tibiofibular syndesmosis injury.Method:A total of 86 patients with ankle joint fracture combined with lower tibiofibular syndesmosis injury who admitted to the Orthopedic Department of Shunchang County Hospital from January 2022 to January 2023 were selected as the study objects,the patients were randomly divided into the control group(43 cases)and the study group(43 cases)according to random number table method.The control group was received lower tibiofibular screw fixation treatment,the study group was received lower tibiofibular ligament repair on the basis of the control group.The perioperative indicators,pain level,ankle joint range of motion,ankle joint function and complications of two groups were compared.Result:Compared with the control group,the study group had more intraoperative bleeding,and longer surgical time,the differences were statistically significant(P<0.05);but there was no statistically significant difference in the hospital stay between two groups(P>0.05).At 3 months,6 months after surgery,the numeric rating scale(NRS)scores in two groups were decreased compared with those before surgery,and those in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).At 6 months after surgery,the plantar flexion and dorsiflexion range of motion of ankle joint in both groups were increased compared with those before surgery,and those in the study group were greater than those in the control group,the differences were statistically significant(P<0.05).At 6 months after surgery,the Baird-Jackson score and American Orthopaedic Foot and Ankle Society(AOFAS)ankle hindfoot scale score in two groups were improved compared with those before surgery,and those in the study group were higher those in the control group,the differences were statistically significant(P<0.05).The incidence of complications in the study group(2.33%)was lower than that in the control group(18.60%),the difference was statistically significant(P<0.05).Conclusion:Lower tibiofibular screw fixation combined with lower tibiofibular ligament repair in the treatment of patients with ankle joint fracture and lower tibiofibular syndesmosis injury may increase intraoperative bleeding and prolong surgical time,but it can reduce patients'pain,promote ankle joint mobility,improve ankle joint function,and reduce the occurrence of complications.