Rigidloop Adjustable可调袢钢板治疗踝关节骨折并下胫腓联合损伤

Rigidloop Adjustable plate for ankle fracture accompanied with distal tibiofibular syndesmotic injuries

目的比较Rigidloop Adjustable(RLA)可调袢钢板与螺钉治疗踝关节骨折合并下胫腓联合损伤的临床效果。方法回顾性分析2019年9月至2022年5月武汉市第三医院收治的44例踝关节骨折合并下胫腓联合损伤的患者。踝关节骨折行切开复位内固定后,下胫腓联合采用RLA可调袢钢板固定22例,2枚皮质骨螺钉三皮质骨固定22例。应用AOFAS踝与后足功能评分、术侧与健侧踝关节活动度平均差值及术前、术后随访时正位X线片下胫腓间隙(tibiofibular bottom clear space,TBCS)、下胫腓重叠距离(tibiofibular bottom overlap,TBOL)比较两组临床效果。结果患者均获得随访,随访时间12~18个月,平均(16.41±1.66)个月。患者踝关节功能满意,无伤口感染、皮肤激惹等并发症。术后3、6、12个月时,RLA可调袢钢板组双侧踝关节活动度差值均显著小于螺钉组,差异有统计学意义(P<0.05);术后3、6、12个月时,两组的AOFAS评分比较,差异无统计学意义(P>0.05);TBCS、TBOL术前、术后即刻、术后3个月及末次随访时,差异无统计学意义(P>0.05)。结论RLA可调袢钢板和螺钉均可有效固定下胫腓联合,与螺钉固定相比,RLA可调袢钢板组可早期功能锻炼,获得更好的踝关节活动度。

Objective To compare the clinical effect of Rigidloop Adjustable(RLA)plate and screw fixation in the treatment of ankle fracture with distal tibiofibular syndesmotic injuries.Methods From September 2019 to May 2022,44 cases of ankle fracture accompanied with distal tibiofibular syndesmotic injuries were treated in Wuhan Third Hospital.After internal fixation of the ankle fracture,the distal tibiofibular syndesmotic was fixed with RLA plate in 22 cases,and 22 cases were fixed with 2 tricortical screws.The AOFAS ankle,hindfoot function scores and the mean difference in ankle range of motion,the tibiofibular bottom clear space(TBCS)and tibiofibular bottom overlap(TBOL)at final follow-up of anteroposterior X-ray between the surgical and unaffected ankle were used to compare the clinical effects of the two groups.Results All patients enrolled in the study were followed up for 12-18 months,with an average of(16.41±1.66)months.All patients had satisfactory ankle joint function and no complications such as wound infection and skin irritation.At 3,6 and 12 months after surgery,the difference in bilateral ankle range of motion in the RLA plate group was significantly lower than that in the screw group,the difference was statistically significant(P<0.05);and the AOFAS score between the groups was not statistically significant(P>0.05).There was no significant difference between TBCS,TBOL before surgery,immediately after surgery,3 months after surgery and last follow-up(P>0.05).Conclusion Both RLA plate and screw can effectively fix the distal tibiofibular syndesmotic,and RLA plate can provide early functional training compared to screw fixation.