Endobutton纽扣钢板弹性固定治疗陈旧性下胫腓联合不稳  

Endobutton elastic fixation for treatment of chronic syndesmotic instability

作　　者：田竞[1] 周大鹏[1] 解冰[1] 刘欣伟[1] 项良碧[1] 

机构地区：[1]沈阳军区总医院骨科,全军重症战创伤救治中心,110840

出　　处：《中华创伤骨科杂志》2014年第7期586-590,共5页Chinese Journal of Orthopaedic Trauma

基　　金：辽宁省自然科学基金（201202241）;Supported by Natural Science Foundation of Liaoning Province （201202241）

摘　　要：目的 探讨Endobutton纽扣钢板弹性固定治疗陈旧性下胫腓联合不稳的疗效. 方法 回顾性分析2011年1月至2013年1月采用Endobutton纽扣钢板弹性固定13例陈旧性下胫腓联合不稳的患者资料,男9例,女4例;年龄32 ～46岁,平均37.5岁.受伤至此次手术的时间为3～6个月,平均3.8个月.术中对内踝和下胫腓联合间隙清创后,采用2枚Endobutton实施下胫腓联合固定.术后3d、8周及6个月复查X线片及CT片,使用影像归档和通信系统测量踝穴和下胫腓联合间隙.术后6个月采用美国足踝外科协会踝关节功能评分（AOFAS）评定疗效.结果 13例患者术后获6～ 28个月（平均16.0个月）随访.踝骨折均获愈合,愈合时间为10 ～17周,平均11.5周.无感染、切口愈合不良及静脉血栓等并发症发生.术后3d、8周和6个月复查X线及CT片提示下胫腓联合复位良好.术后6个月AOFAS踝关节节功能评分结果：评分从术前平均49.5分上升至71.6分;优7例,良5例,可1例. 结论 Endobutton纽扣钢板弹性固定治疗陈旧性下胫腓联合不稳具有保留下胫腓联合生理微动、无需二次手术取出及避免下胫腓联合再分离等优点,患者术后踝关节功能恢复良好、无明显并发症发生,短期疗效满意.Objective To observe the clinical efficacy of Endobutton elastic fixation for treatment of chronic syndesmotic instability.Methods From January 2011 to January 2013,13 cases of chronic syndesmotic instability were treated by Endobutton elastic fixation in our department.They were 9 men and 4 women,aged from 32 to 46 years （average,37.5 years）.The duration from injury to the operative treatment ranged from 3 to 6 months （average,3.8 months）.After debridement of the medial gutter and the inferior tibiofibular space,2 Endobutton plates instead of traditional metal screws were used to stabilize the syndesmosis.Follow-up included clinical evaluation,X-ray and CT examination and image-based PACS 5.0 system measurement at 3 days,8 weeks and 6 months postoperation.The American Orthopaedic Foot and Ankle Society （AOFAS） score system was used for postoperative efficacy evaluation at 6 months postoperation.Results The patients were followed for 6 to 28 months,with an average of 16.0 months.All the malleolus fractures healed after an average of 11.5 weeks （from 10 to 17 weeks）.No infection,faulty wound healing or phlebothrombosis happened in this group.Reduction of the syndesmosis was confirmed by X-ray and CT scan 3 days,8 weeks and 6 months after the surgery.The mean AOFAS score improved significantly from 49.5 points to 71.6 points,with 7 excellent cases,5 fine cases and one fair case.Conclusions Endobutton elastic fixation for chronic syndesmotic instability can preserve physiological fretting of the syndesmosis and avoid removal of hardware and further separation of the syndesmosis.It may also lead to fine functional recovery of the ankle,absence of significant complications and satisfactory outcomes in a short-term.

关 键 词：踝关节 骨折固定术 内 关节不稳定性 

分 类 号：R687.3[医药卫生—骨科学]