可吸收与金属螺钉固定Maisonneuve骨折比较

Absorbable versus metal screws for internal fixation of Maisonneuve's fractures

[目的]比较可吸收与金属螺钉内固定治疗Maisonneuve骨折的临床疗效。[方法]回顾性分析本科2020年1月—2021年10月收治31例Maisonneuve骨折患者的资料,均行骨折切开复位内固定术,其中15例采用可吸收螺钉进行固定,16例采用金属螺钉固定。比较两组围手术期、临床及影像结果。[结果]两组患者在手术时间、切口总长度、术中失血量、术中透视次数、切口愈合、住院时间的差异均无统计学意义(P>0.05)。随访时间平均(19.2±4.6)个月。可吸收钉组术后恢复完全负重活动时间显著早于金属钉组[(70.4±8.6) d vs (84.6±5.6) d, P<0.001]。随术后时间推移,两组的AOFAS评分、踝背伸-跖屈ROM均显著增加,而VAS评分显著减小(P<0.05)。术后3个月,可吸收钉组的踝背伸-跖屈ROM显著大于金属钉组[(42.5±3.6)°vs (38.2±4.9)°, P=0.009],但术后12个月和末次随访时两组差异已无统计学意义(P>0.05)。相同时间点,两组的AOFAS评分、VAS评分的差异均无统计学意义(P>0.05)。影像方面,两组术后骨折复位质量的差异无统计学意义(P>0.05)。与术前相比,末次随访时两组的MCS、TFCS均显著减少(P<0.05),而TFO显著增加。在相同的时间点,两组间MCS、TFCS、TFO的差异均无统计学意义(P>0.05)。至末次随访时,两组患者骨折均愈合,愈合时间差异无统计学意义(P>0.05)。[结论]可吸收螺钉固定治疗Maisonneuve骨折的疗效与金属螺钉相似,可早期负重锻炼,无需二次手术取出。

[Objective] To compare the clinical efficacy of absorbable versus metal screws for internal fixation of Maisonneuve fractures. [Methods] A retrospective study was conducted on 31 patients who received surgical treatment for Maisonneuve fractures in our department from January 2020 to October 2021. Based on preoperative surgeon-patient discussion, 15 patients had internal fixation with absorbable screws, while the remaining 16 patients were with metal screws. The perioperative, clinical and imaging documents were compared between the two groups. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, incision healing grade and hospital stay between the two groups(P>0.05). All patients in both groups were followed up for a mean of(19.2±4.6) months, and the absorbable group resumed full weight-bearing activity significantly earlier than the metal group [(70.4±8.6) days vs(84.6±5.6) days, P<0.001]. As time went by, the AOFAS score and ankle dorsal-plantar flexion ROM in both groups increased significantly, while the VAS score decreased significantly(P<0.05). At 3 months after surgery, the absorbable group proved significantly superior to the metal group regarding ankle dorsal-plantar flexion ROM [(42.5±3.6)° vs(38.2±4.9)°, P=0.009], whereas which turned to be no significant difference between the two groups at 12 months after surgery and the last follow-up(P>0.05). In addition,there were no statistically significant differences in terms of AOFAS and VAS scores between the two groups at any time points accordingly(P>0.05). With respect to imaging, there was no statistically significant difference in postoperative fracture reduction quality between the two groups(P>0.05). Compared with those preoperatively, the medial clear space(MCS) and tibiofibular clear space(TFCS) in both groups significantly declined(P<0.05), while the tibiofibular overlap(TFO) increased significantly at the last follow-up(P<0.05), which proved not statistically significant between the two groups at any matching time points(P>0.05). At the last follow-up, all patients in both group got the injury healed well with on a statistically significant difference in healing time between them(P>0.05). [Conclusion] The absorbable screw fixation does achieve similar clinical consequence with the metal counterpart for Maisonneuve fracture, however, the former has advantages of early weight-bearing exercise and no need for secondary surgery to remove the implant over the latter.