腓骨骨膜移位法治疗踝关节骨折并下胫腓联合分离的临床疗效

Clinical efficacy of fibular periosteal displacement in the treatment of ankle joint fractures with separation of the lower tibiofibular syndesmosis

目的观察腓骨骨膜移位法治疗踝关节骨折并下胫腓联合分离的临床疗效。方法回顾性选取2020年2月至2022年2月北京市丰台中西医结合医院收治的踝关节骨折并下胫腓联合分离患者97例,依据手术方法不同分为腓骨骨膜移位法组(n=51)和短肌腱移位法组(n=46)。对比分析两组患者的围手术期指标[术中出血量、术中C型臂X线机透视次数、操作角度、手术时间、固定时间、完全负重时间、骨折愈合时间、术后1个月视觉模拟评分法(VAS)评分]、关节形态[内侧关节间隙(MW)、下胫腓间隙(TBCS)、下胫腓重叠距离(TBOL)]、骨代谢指标[β-I型胶原羧基端交联肽(β-CTX)、骨碱性磷酸酶(BALP)、骨钙素、踝关节活动度[外翻、内翻、跖屈、背伸]、踝关节功能[Baird评分、Maryland评分、美国足与踝关节协会(AOFAS)踝-后足评分、足踝功能障碍指数(FADI)]、临床疗效及并发症发生情况。结果腓骨骨膜移位法组患者的术中出血量、术中C型臂X线机透视次数均少于短肌腱移位法组,操作角度大于短肌腱移位法组,手术时间长于短肌腱移位法组,固定时间、完全负重时间均短于短肌腱移位法组,术后1个月VAS评分低于短肌腱移位法组,差异均有统计学意义(P<0.05),但两组患者的骨折愈合时间比较,差异无统计学意义(P>0.05)。腓骨骨膜移位法组患者的MW、TBOL、BALP、骨钙素水平均明显高于短肌腱移位法组,TBCS、β-CTX水平均明显低于短肌腱移位法组,差异均有统计学意义(P<0.05)。腓骨骨膜移位法组患者的外翻、内翻、跖屈、背伸、Baird评分、Maryland评分、AOFAS评分、FADI评分均明显高于短肌腱移位法组,差异均有统计学意义(P<0.05)。腓骨骨膜移位法组患者的优良率明显高于短肌腱移位法组,差异有统计学意义(P<0.05)。腓骨骨膜移位法组患者的并发症发生率明显低于短肌腱移位法组,差异有统计学意义(P<0.05)。结论腓骨骨膜移位法手术治疗踝关节骨折并下胫腓联合分离的临床效果明显优于短肌腱移位法,更能减少患者的术中出血量、术中C型臂X线机透视次数,增大操作角度,缩短固定时间,缓解患者疼痛,提早患者完全负重时间,改善患者骨代谢,增大患者踝关节活动度,改善患者踝关节功能,提升临床疗效,并减少患者术后并发症的发生。

Objective To investigate the clinical efficacy of fibular periosteal displacement in the treatment of ankle joint fractures with separation of the lower tibiofibular syndesmosis.Methods A total of 97 patients with ankle fracture and distal tibiofibular syndesmosis separated admitted to Beijing Fengtai Hospital of Integrated Traditional Chinese and Western Medicine from February 2020 to February 2022 were retrospectively selected,and they were divided into two groups according to different surgical methods:fibula periosteum transposition group(n=51)and short tendon transposition group(n=46 cases).The perioperative indicators of two groups of patients[intraoperative bleeding volume,intraoperative C-arm X-ray machine fluoroscopy frequency,operating angle,surgical time,fixation time,complete weight-bearing time,fracture healing time,VAS score at 1 month after surgery],joint morphology[medial joint space(MW),lower tibiofibular space(TBCS),lower tibiofibular overlap distance(TBOL)],bone metabolism indicators[β-C-terminal cross-linked peptide of type I collagen(β-CTX),bone alkaline phosphatase(BALP),osteocalcin,ankle joint activity[valgus,varus,plantar flexion,dorsiflexion],ankle joint function[baird score,maryland score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle posterior foot score,ankle dysfunction index(FADI)],clinical efficacy and incidence of complications were compared and analyzed.Results The intraoperative bleeding volume of patients in the fibular periosteal transfer group was significantly lower than that in the short tendon transfer group,the number of C-arm X-ray machine fluoroscopy times during surgery was significantly lower than that in the short tendon transfer group,the operating angle was significantly greater than that in the short tendon transfer group,the surgical time was significantly longer than that in the short tendon transfer group,and the fixation time and complete weight bearing time were significantly shorter than those of the short tendon transfer group,the VAS at one month after surgery was significantly lower than that of the short tendon transfer group,the differences were statistically significant(P<0.05),however,there was no statistically significant difference in the fracture healing time between the two groups of patients(P>0.05).The levels of MW,TBOL,BALP,and BGP in the fibular periosteal transfer group were significantly higher than those in the short tendon transfer group,the levels of TBCS,β-CTX were significantly lower than those of the short tendon transfer group,the differences were statistically significant(P<0.05).The patients in the fibular periosteal transfer group had significantly higher eversion,varus,plantar flexion,dorsiflexion,Baird score,Maryland score,AOFAS score,and FADI score than those in the short tendon transfer group,the differences were statistically significant(P<0.05).The excellent and good rates of patients in the fibular periosteal transfer group was significantly higher than that in the short tendon transfer group,and the difference was statistically significant(P<0.05).The incidence of complications in the fibular periosteal transfer group was significantly lower than that in the short tendon transfer group,and the difference was statistically significant(P<0.05).Conclusion Fibula periosteum transposition is significantly better than short tendon transposition in the treatment of ankle fracture combined with lower tibiofibular union.It can also reduce the intraoperative bleeding volume and the number of C-arm X-ray fluoroscopy times of patients,increase the operating angle,shorten the fixation time,alleviate pain,advance the patient’s complete weight-bearing time,improve bone metabolism,increase the patient's ankle joint mobility,improve ankle joint function,enhance clinical efficacy,and reduce the occurrence of postoperative complications.