无头双加压螺钉内固定对伴下胫腓联合韧带损伤的踝关节骨折患者康复进程与骨折愈合及功能恢复的影响

The effect of headless double compression screw internal fixation on the rehabilitation process,fracture healing,and functional recovery of ankle fractures with associated lower tibiofibular syndesmosis ligament injury

目的探讨无头双加压螺钉内固定在伴下胫腓联合韧带损伤的踝关节骨折患者中的应用。方法依据纳入标准与排除标准本研究共纳入104例,按随机数字表法分为观察组和对照组,每组52例。观察组行无头双加压螺钉内固定,对照组行空心螺钉内固定。观察两组手术指标、踝关节功能优良率、并发症及手术前后踝关节活动度、炎症指标[C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)、IL-8]及硫化氢、鸢尾素血清含量。结果观察组骨折愈合时间短于对照组,差异有统计学意义(t=9.767,P=0.000);术后3个月,观察组踝关节功能优良率72.55%高于对照组52.00%,差异有统计学意义(χ^(2)=4.543,P=0.033);术后6个月,观察组踝关节功能优良率96.08%与对照组88.00%相比,差异无统计学意义(χ^(2)=2.259,P=0.133);术后3个月、6个月,观察组踝关节背伸、跖屈、前旋、后旋角度大于对照组,差异有统计学意义(术后3个月t值依次为8.242、13.871、17.865、11.241,术后6个月t值依次为7.126、8.840、5.935、9.414,均P=0.000);术后1周、1个月、3个月,观察组血清IL-6、CRP、IL-8水平低于对照组,差异有统计学意义(术后1周t值依次为5.772、9.640、8.877,术后1个月t值依次为9.169、18.714、16.305,术后3个月t值依次为8.059、16.775、14.960,均P=0.000);术后1个月、3个月,观察组血清硫化氢、鸢尾素水平高于对照组,差异有统计学意义(术后1个月t值依次为4.028、5.348,均P=0.000,术后3个月t值依次为2.951、3.256,P值依次为0.004、0.002);观察组延迟愈合发生率1.96%低于对照组18.00%,差异有统计学意义(χ^(2)=7.081,P=0.008)。结论在不做踝切口情况下,无头双加压螺钉内固定可使踝关节骨折获取解剖复位,相比空心螺钉固定,可减轻对骨折周围软组织及血运刺激,加速骨折愈合,促进踝关节功能早期康复。

Objective To investigate the application of headless double compression screw internal fixation in patients with ankle fractures accompanied by lower tibiofibular syndesmosis ligament injury.Methods A total of 104 patients with tibiofibular syndesmosis injury and ankle fracture in our Hospital from May 2021 to June 2022 were selected and divided into two groups with 52 cases in each group by random number table method.The control group received internal fixation with hollow screws and the observation group received internal fixation with headless double pressure screws.Surgical indexes,excellent and good ankle function rate,complications,ankle motion,inflammatory indexes[C-reactive protein(CRP),interleukin-6(IL-6),IL-8]and serum levels of hydrogen sulfide and irisin in the two groups were observed.Results The fracture healing time in the observation group was shorter than that in the control group,the differences were statistically significant(t=9.767,P=0.000).Three months after surgery,the excellent and good ankle function rate in the observation group(72.55%)was higher than that in the control group(52.00%),and the differences were statistically significant(χ^(2)=4.543,P=0.033).Six months after operation,the excellent and good ankle function rate of the observation group was 96.08%.Compared with 88.00% of the control group,no significant difference was observed(χ^(2)=2.259,P=0.133).At 3 and 6 months after surgery,the ankle dorsalis,plantar flexes,anterior rotation and posterior rotation angles in the observation group were higher than those in the control group,and the differences were statistically significant(t at 3 months after surgery was 8.242,13.871,17.865,11.241,and t at 6 months after surgery was 7.126,8.840,5.935,9.414,all P=0.000);at 1 week,1 month and 3 months after surgery,the levels of serum IL-6,CRP and IL-8 in the observation group were lower than those in the control group,and the differences were statistically significant(t at 1 week after surgery was 5.772,9.640,8.877;t at 1 month after surgery was 9.169,18.714,16.305;t at three months after surgery was 8.059,16.775,14.960;all P=0.000).At 1 and 3 months after surgery,the serum levels of hydrogen sulfide and irisin in the observation group were higher than those in the control group,and the differences were statistically significant(t 1 month after surgery was 4.028,5.348,all P=0.000;t 3 months after surgery was 2.951,3.256,P was 0.004,0.002).The incidence of delayed healing in the observation group was 1.96%,which was lower than 18.00% in the control group,and the differences were statistically significant(χ^(2)=7.081,P=0.008).Conclusions Without making an ankle incision,the internal fixation of headless double compression screws can achieve anatomical reduction of ankle fractures,which can reduce the stimulation of soft tissue and blood circulation around the fracture,accelerate fracture healing,and promote early rehabilitation of ankle joint function compared to hollow screw fixation.