两种固定方式治疗旋后外旋Ⅳ°踝关节骨折合并下胫腓联合分离的疗效分析  

The analysis of 2 fracture fixation to cure the supination external rotation Ⅳ degree ankle fracture with tibiofibular syndesmosis separation

作　　者：王永永[1] 贾代良[2] 张刚[3] 于宝华[3] 雷学锋[2] WANG Yongyong JIA Dailiang ZHANG Gang YU Baohua LEI Xuefeng(Jining Medical University, Jining 272067, China School of Clinical Medicine ,Jining Medical University ,Jining 272067, China The Affiliated Hospital of Jining Medical University, Jining 272029, China)

机构地区：[1]济宁医学院,济宁272067 [2]济宁医学院临床医学院,济宁272067 [3]济宁医学院附属医院,济宁272029

出　　处：《济宁医学院学报》2017年第1期28-31,共4页Journal of Jining Medical University

基　　金：山东省自然科学基金(ZR2015HL027)

摘　　要：目的比较单纯修复下胫腓前、后韧带及前、后结节和螺钉固定下胫腓联合治疗旋后外旋型Ⅳ°踝关节骨折合并下胫腓联合分离的临床疗效。方法选取2014年1月至2015年9月收治于我院骨科旋后外旋型Ⅳ°踝关节骨折合并下胫腓分离患者37例,其中单纯修复下胫腓前、后韧带及前、后结节,不用螺钉固定下胫腓联合患者17例即观察组;直接用螺钉固定下胫腓联合患者20例即对照组。术后3天及末次随访分别拍X线片,测量下胫腓间隙(TBCS)、下胫腓重叠距离(TBOL),并在末次随访时对踝关节功能进行AOFAS评分,评价治疗效果。结果 37例均获随访,时间12~18个月,平均16.6个月。术后3天及末次随访X线片检查测量下胫腓间隙、下胫腓重叠距离均无显著性差异(t分别为0.82,0.37,0.96,0.83,P均>0.05),术后12~18个月两组AOFAS踝关节功能评分(t=0.68,P>0.05)及优良率(χ~2=0.87,P>0.05)均无显著性差异。对照组于术后2周出现1例踝关节疼痛患者,术后12周取出螺钉后缓解。结论对于旋后外旋型Ⅳ°踝关节骨折合并下胫腓联合分离患者,单纯修复下胫腓前、后韧带及下胫腓前、后结节,同样可以达到下胫腓螺钉固定的效果。Objective To compare the clinical efficacy of 2 fixation of the supination external rotation IV degree ankle fracture with tibiofibular syndesmosis separation with simple repair the anterior,posterior tibio- fibular ligament and tuberosity and screw fixation. Methods 37 patients were divided into two groups ac- cording to different methods of fracture fixation. 17 patients were only to fix the tibiofibular anterior and pos- terior tuberosity and repair the anterior and posterior ligament, inferior tibiofibular syndesmosis without screw fixation （ Observation group ）. 20 patients were fixed with inferior tibiofibular syndesmosis screw （ Control group ）. We evaluated the ankle by the inferior tibiofibular clear space （TBCS） and inferior tibiofib- ular overlap distance （TBOL） at 3 days and at the last follow up X-ray examination and AOFAS ankle score at the last follow up. Results All patients were followed up with an average of 16.6 months （ ranging from 12 to18 months）. According to the X-ray postoperative 3days and the last follow up, there was no significant difference between TBCS and TBOL （ respectively t = 0. 82,0. 37,0. 966,0.83, P 〉 0.05 ）. The AOFAS ankle score at the last followed up （ t = 0.68 ,P 〉 0.05 ） and the excellence rate of the two groups （ X2 = 0.865 ,P 〉 0.05 ） were no significant difference （ P 〉0.05 ）. In the control group,one patient felt ankle joint pain at 2weeks postoperatively,and was relieved after the screws were removed at 12 weeks postoperatively. Conclusion Simple fixation of anterior and posterior tibiofibular ligament and tuberosity may achieve the effect of syndes- mosis screws to repair anterior tibiofibular for the patient of supination external rotation IV degree ankle fracture with syndesmosis separation.

关 键 词：踝关节骨折 旋后外旋型Ⅳ° 下胫腓联合分离 手术治疗 

分 类 号：R683.42[医药卫生—骨科学]