下胫腓钩与Suture-button技术治疗下胫腓联合损伤  

Distal tibiofibular hook and suture-button technique for treatment of tibiofibular syndesmosis injury：a comparative study

作　　者：芦浩[1] 徐海林[1] 姜保国[1] 付中国[1] 张殿英[1] 王天兵[1] 张培训[1] 薛峰[1] 陈建海[1] 党育[1] 杨明[1] 

机构地区：[1]北京大学人民医院创伤骨科,100044

出　　处：《中华创伤杂志》2015年第2期117-120,共4页Chinese Journal of Trauma

基　　金：国家重点基础研究发展计划资助项目（2014CB542200）;教育部创新团队基金资助项目（IRT1201）;国家自然科学基金资助项目（31271284）;教育部新世纪人才基金资助项目（BMU20110270）;卫生部卫生公益性行业专项基金资助项目（201302007）

摘　　要：目的 比较下胫腓钩和Suture-button技术治疗合并踝关节骨折的下胫腓联合损伤的临床效果. 方法 2005年1月-2013年9月采用下胫腓钩（下胫腓钩组）和Suture-button技术（Suture-button组）治疗合并踝关节骨折的下胫腓联合损伤患者.下胫腓钩组患者20例,其中男14例,女6例;年龄21 ～69岁,平均34.4岁.骨折按Danis-Weber分型：B型5例,C型15例;按Lauge-Hansen分型：旋后外旋型3例,旋前外展型5例,旋前外旋型12例.Suture-button组患 者14例,其中男8例,女6例;年龄24 ～ 44岁,平均28.7岁.骨折按Denis-Weber分型：B型3例,C型11例;按Lauge-Hansen分型：旋后外旋型3例,旋前外展型3例,旋前外旋型8例.采用美国足踝外科协会（AOFAS）评分评价骨折愈合情况以及下胫腓联合复位的情况. 结果 31例患者获得随访11 ～114个月,平均63.5个月.下胫腓钩组AOFAS评分84～ 100分,平均88.3分.Suture-button组AOFAS评分85 ～100分,平均90.5分（P＞0.05）.所有骨折愈合,未出现下胫腓联合再次分离.下胫腓钩组患者于初次手术后12周行二次手术取出下胫腓钩,其余内固定在距离初次手术后（12.4＆#177;1.4）个月（11～ 15个月）行第三次手术取出.Suture-button组3例于术后12个月取出全部内固定物,其余患者均未取出内固定物. 结论 采用下胫腓钩或Suture-button技术弹性固定下胫腓联合损伤可以取得满意的临床效果,而Suture-button技术在手术入路的选择和二次手术取出内固定方面较下胫腓钩具有优势.Objective To compare the clinical results of tibiofibular syndesmosis injury repaired with distal tibiofibular hook and suture-button technique.Methods From January 2005 to September 2013,34 cases of tibiofibular syndesmosis injury combined with ankle fracture were repaired with distal tibiofibular hook （n =20） or Suture-button （n =14）.In distal tibiofibular hook group,there were 14 males and 6 females aged 21-69 years （mean,34.4 years）.Fracture was classified as 5 type B and 15 type C using Danis-Weber system,and 3 supination-external rotation type,5 pronation-abduction type,and 12 pronation-external rotation type using Lauge-Hansen classification.In suture-button group,there were 8 men and 6 women aged 24-44 years （mean,28.7 years）.Fracture was classified as 3 type B and 11 type C using Danis-Weber system,and 3 supination-external rotation type,3 pronation-abduction type,and 8 pronation-external rotation type using Lauge-Hansen classification.American Orthopedic Foot and Ankle Society （AOFAS） score was used for evaluation of bone union and syndesmosis reduction.Results Thirtyone patients were followed up for 11-114 months （mean,63.5 months）.Mean AOFAS was 88.3 points （range,84-100 points） in tibiofibular hook group,and was 90.5 points （range,85-100 points） in suture-button group （P 〉 0.05）.All fractures were united without recurrent syndesmosis diastasis.In tibiofibular hook group,the hook was removed 12 weeks after the primary operation and other instruments were removed （12.4 ＆#177; 1.4） months （range,11-15 months） after the primary operation.In suture-button group,3 cases had removal of all instruments within 12 months postoperatively.Conclusion Distal tibiofibular hook or suture-button is an effective way to repair the syndesmosis,but suture-button has the advantages of operative approaeh selection and implant removal.

关 键 词：胫骨骨折 腓骨 踝损伤 下胫腓联合 

分 类 号：R687.3[医药卫生—骨科学]