下胫腓联合复位质量对军事训练中旋转型踝关节骨折弹性固定效果影响的分析

Influence of reduction quality of the syndesmosis in combined tibiofibulaRelastic fixation foRrotary ankle fractures following military training

目的评估下胫腓联合弹性固定后其复位质量是否会影响踝关节旋转骨折伤员弹性固定的短期临床疗效。方法回顾性研究2015年2月—2020年2月在南部战区海军第一医院接受下胫腓联合弹性固定患者59例,男性32例,女性27例;年龄19~29岁,平均19.3岁。外翻-外旋(SER)Ⅳ型损伤48例,内翻-外旋(PER)Ⅳ型损伤11例。术后3 d内通过CT图像评估下胫腓联合复位情况。测量胫骨远端关节面上方1 cm处前后切迹的距离,评价腓骨相对于胫骨的旋转程度。根据影像学结果,依据联合韧带复位情况分为解剖复位组(24例)和复位不良组(35例)。术后12个月采用美国足踝外科协会(AOFAS)踝-后足评分和足踝结局评分(FAOS)评价足踝功能,采用VAS评价主观痛感。术后12个月,在常规置入物取出过程中再次行关节镜检查。结果在59例接受下胫腓联合弹性固定的伤员中,术后12个月取出置入物的同时再次踝关节镜检查明确下胫腓联合稳定性。术后12个月,解剖复位组AOFAS踝-后足评分、FAOS评分和VAS分别为(90.3±3.8)分、(94.2±2.4)分和(2.4±0.3)分,复位不良组分别为(90.6±2.6)分、(94.5±2.1)分和(1.4±0.6)分。两组之间比较差异无统计学意义(P>0.05)。结论术后12个月,下胫腓联合弹性固定后下胫腓联合早期复位质量并不影响临床结局。

Objective To evaluate whetheRthe reduction quality of the syndesmosis in tibiofibulaRelastic fixation affects the short-term clinical results in patients with rotational ankle fractures.Methods A total of 59 patients(32 males and 27 females aged 19-29 years,mean 19.3 years)with rotational ankle fractures who underwent elastic fixation of the distal tibiofibulaRsyndesmosis at the First Navy Hospital,Southern TheateRCommand between Feb.2015 and Feb.2020 were retrospectively studied.There were 48 supination external rotation(SER)typeⅣcases and 11 promation external rotation(PER)typeⅣcases.The reduction quality of the syndesmosis was assessed by CT scan within 3 d afteRsurgery.The distance between the anterioRand posterioRnotches 1 cm above the articulaRsurface of the distal tibia was measured to evaluate the degree of rotation of the fibula relative to the tibia.According to the imaging results,patients were divided into anatomical reduction group(n=24)and pooRreduction group(n=35).Twelve months afteRsurgery,the foot and ankle functional recovery was evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score as well as foot and ankle outcome score(FAOS).The pain was evaluated using the subjective visual analogue scale(VAS).Results FoRall the 59 patients,the implant was removed at 12 months afteRsurgery and ankle arthroscopy was performed again to identify the stability of the syndesmosis.At 12 months,the AOFAS ankle-hindfoot score,FAOS,and VAS were respectively 90.3±3.8,94.2±2.4,2.4±0.3,in the anatomical reduction group,and 90.6±2.6,94.5±2.1 and 1.4±0.6,in the pooRreduction group,revealing no significant difference between the two groups(P>0.05).Conclusion Early reduction quality of the distal tibiofibulaRsyndesmosis in combined tibiofibulaRelastic fixation foRrotational ankle fractures does not affect the clinical outcome at 12 months.