全内关节镜下克氏针联合Suture‑Bridge技术与单纯克氏针固定治疗陈旧性外踝撕脱骨折的疗效比较

Comparison of the efficacy of Kirschner wire fixation combined with Suture‑Bridge technique and simple Kirschner wire fixation in the treatment of old lateral malleolar avulsion fractures under all‑inside arthroscopy

目的比较全内关节镜下克氏针联合Suture‑Bridge技术与单纯克氏针固定治疗陈旧性外踝撕脱骨折的疗效。方法采用回顾性队列研究分析2018年1月至2022年6月徐州市中心医院收治的56例陈旧性外踝撕脱骨折患者的临床资料,其中男32例(32足),女24例(24足);年龄19~57岁[(35.2±11.1)岁]。25例采用全内关节镜下克氏针固定治疗(克氏针组),31例采用全内关节镜下克氏针联合Suture‑Bridge技术治疗(克氏针联合缝合组)。比较两组手术时间、术后2周切口愈合情况、术后6个月骨折愈合率;术前,术后3、6个月及末次随访时美国足踝外科协会(AOFAS)踝‑后足评分、足踝能力量表(FAAM)评分[包含日常生活能力(ADL)评分和运动功能(S)评分];术后3、6个月及末次随访时前抽屉试验;术后重返运动时间;并发症发生率。结果患者均获随访12~18个月[(14.2±2.2)个月]。克氏针联合缝合组手术时间为(56.3±12.5)min,长于克氏针组的(41.1±8.2)min(P<0.01)。术后2周两组切口均Ⅰ期愈合。术后6个月,克氏针联合缝合组骨折均愈合(100%),克氏针组22例(88%)骨折愈合(P<0.05)。两组术前AOFAS踝‑后足评分、FAAM‑ADL评分和FAAM‑S评分差异均无统计学意义(P>0.05)。术后3、6个月及末次随访时,克氏针联合缝合组AOFAS踝‑后足评分为(89.7±3.4)分、(92.8±2.8)分、(94.9±3.3)分,均高于克氏针组的(87.4±4.4)分、(90.4±4.1)分、(92.5±4.6)分(P<0.05);克氏针联合缝合组FAAM‑ADL评分为(90.1±3.5)分、(91.5±2.9)分、(92.8±3.0)分,FAAM‑S评分为(91.4±5.4)分、(92.8±5.0)分、(94.4±4.8)分,均高于克氏针组的(86.8±5.0)分、(88.7±3.8)分、(90.3±3.7)分和(88.0±5.3)分、(89.5±4.8)分、(91.5±5.2)分(P<0.05或0.01)。两组术后各时间点AOFAS踝‑后足评分、FAAM‑ADL评分和FAAM‑S评分均较术前提高,且随随访时间延长而逐渐增加(P<0.01)。两组术后各时间点前抽屉试验均为阴性。克氏针联合缝合组术后重返运动时间为(9.2±1.3)周,早于克氏针组的(10.3±1.5)周(P<0.01)。克氏针联合缝合组克氏针松动、退针1例(3.2%),克氏针组克氏针松动、退针3例(12.0%)(P>0.05)。两组均未出现神经、肌腱损伤等并发症。结论与全内关节镜下单纯克氏针固定相比,全内关节镜下克氏针联合Suture‑Bridge技术治疗陈旧性外踝撕脱骨折,骨折愈合率更高,患者生活质量和足踝功能改善更明显,重返运动时间更早。

Objective To compare the efficacy of Kirschner wire fixation combined with Suture‑Bridge technique and simple Kirschner wire fixation in the treatment of old lateral malleolar avulsion fractures under all‑inside arthroscopy.Methods A retrospective cohort study was conducted to analyze the clinical data of 56 patients with old lateral malleolar avulsion fractures,admitted at Xuzhou Central Hospital from January 2018 to June 2022,including 32 males(32 feet)and 24 females(24 feet),aged 19‑57 years[(35.2±11.1)years].Twenty‑five patients were treated with Kirschner wire fixation under all‑inside arthroscopy(K‑wire group),while the other 31 patients were treated with Kirschner wire fixation combined with Suture‑Bridge technique under all‑inside arthroscopy(K‑wire combined with suture group).The surgical time,incision healing at 2 weeks after surgery,and fracture healing rate at 6 months after surgery of the two groups were detected.The American Orthopedic Foot and Ankle Society(AOFAS)ankle‑hindfoot scores,and foot and ankle ability measure(FAAM)scores[including activities of daily living(ADL)scores and sports function(S)scores]of the two groups were assessed before surgery,at 3,6 months after surgery,and at the last follow‑up.The anterior drawer test was performed at 3,6 months after surgery and at the last follow‑up.The time of return to sports after surgery and complication rates were also recorded.Results All the patients were followed up for 12‑18 months[(14.2±2.2)months].The surgical time in the K‑wire combined with suture group was(56.3±12.5)minutes,longer than(41.1±8.2)minutes in the K‑wire group(P<0.01).The incisions in both groups were healed by first intention at 2 weeks after surgery.In the K‑wire combined with suture group,all the fractures were healed at 6 months after surgery(100%),while in the K‑wire group 22 patients(88%)obtained fracture healing(P<0.05).There were no statistically significant differences in the AOFAS ankle‑hindfoot scores,FAAM‑ADL scores,or FAAM‑S scores between the two groups preoperatively(P>0.05).At 3,6 months after surgery,and at the last follow‑up,the AOFAS ankle‑hindfoot scores in the K‑wire combined with suture group were(89.7±3.4)points,(92.8±2.8)points,and(94.9±3.3)points respectively,higher than(87.4±4.4)points,(90.4±4.1)points,and(92.5±4.6)points in the K‑wire group(P<0.05);the FAAM‑ADL scores and the FAAM‑S scores in the K‑wire combined with suture group were(90.1±3.5)points,(91.5±2.9)points,(92.8±3.0)points and(91.4±5.4)points,(92.8±5.0)points,(94.4±4.8)points respectively,higher than(86.8±5.0)points,(88.7±3.8)points,(90.3±3.7)points and(88.0±5.3)points,(89.5±4.8)points,(91.5±5.2)points(P<0.05 or 0.01).The AOFAS ankle‑hindfoot scores,FAAM‑ADL scores,and FAAM‑S scores at all postoperative time points were higher than those preoperatively and increased with the passage of the follow‑up time(P<0.01).The results of the anterior drawer test at all postoperative time points in the two groups were negative.The time of return to sports after surgery in the K‑wire combined with suture group was(9.2±1.3)weeks,shorter than(10.3±1.5)weeks in the K‑wire group(P<0.01).One patient(3.2%)in the K‑wire combined with suture group and 3 patients(12.0%)in the K‑wire group had Kirschner wire loosening and withdrawal(P>0.05).Neither of the two groups developed complications such as nerve or tendon injuries.Conclusion Compared with simple Kirschner wire fixation under all‑inside arthroscopy,Kirschner wire fixation combined with Suture‑Bridge technique under all‑inside arthroscopy achieves higher fracture healing rate,more obvious improvement in life quality and ankle function,as well as earlier return to sports in the treatment of old lateral malleolar avulsion fractures.