下胫腓螺钉固定患者的功能及影像学结果  

A comparative study on the function and imaging results of the patients with the syndesmosis screw fixation

作　　者：沈彦[1] 王朝阳[1] 吴荣[1] 

机构地区：[1]解放军第98医院骨五科,浙江湖州313000

出　　处：《临床骨科杂志》2017年第2期211-213,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨下胫腓螺钉固定是否影响患者的功能及影像学结果。方法回顾性研究78例行下胫腓螺钉固定的踝关节骨折患者的临床资料,比较下胫腓螺钉完整(完整组)、断裂或松动(断裂松动组)、取出(取出组)3组的功能及影像学结果。功能评价使用Lower Extremity Measure(LEM)下肢测量评分和Olerud Molander(OM)踝部功能评分;影像学评价包括下胫腓间隙、下胫腓重叠和内侧间隙。结果患者均获得随访,时间12~32个月。完整组、断裂松动组、取出组的LEM评分和OM评分分别为(70.3±6.3)分和(46.5±7.9)分、(83.3±3.0)分和(62.2±4.9)分、(88.1±4.8)分和(66.8±6.7)分,断裂松动组和取出组的两项评分均优于完整组,差异有统计学意义(P<0.05);断裂松动组与取出组之间差异无统计学意义(P>0.05)。下胫腓间隙完整组为(3.2±0.2)mm,断裂松动组、取出组分别为(4.1±0.2)mm、(4.1±0.3)mm,断裂松动组和取出组均宽于完整组(P<0.05),断裂松动组与取出组之间差异无统计学意义(P>0.05)。下胫腓重叠和内测间隙3组比较差异无统计学意义(P>0.05)。螺钉直径对患者功能没有影响。结论与松动断裂组、取出组相比,完整组下胫腓螺钉功能评分更差。螺钉松动或断裂不会影响功能,但在螺钉完整情况下却有取出指针。Objective To determine whether functional outcomes and radiographic results after ankle fracture are affected by the status of the syndesmosis screw. Methods Retrospectively studied of 78 patients with ankle fracture were treated with tibiofibular syndesmosis screw fixation,who completed formal functional testing. Patients with intact,fracture or loose,or removed syndesmosis screws were compared. Functional outcomes were measured by using the Lower Extremity Measure（ LEM） and the Olerud Molander（ OM） ankle score. Radiologic review included tibiofibular clear space,tibiofibular overlap and medial clear space. Results All patients got follow-up for 12 - 32 months. The LEM score for patients with intact screws was（ 70. 3 ± 6. 3） compared with（ 83. 3 ± 3. 0） for fractured or loosened screws,（ 88. 1 ± 4. 8） for removed screws. The OM ankle score for patients with intact screws was（ 46. 5 ± 7. 9）compared with（ 62. 2 ± 4. 9） for fractured or loosened screws,（ 66. 8 ± 6. 7） for removed screws. Functional outcomes were more improved in patients with fractured or loosened,and removed screws compared with those with intact screws both in LEM and OM outcomes（ P〈0. 05）. There was no difference in outcome comparing fractured or loosened,and removed screws（ P〈0. 05）. The tibiofibular clear space for intact screws was（ 3. 2 ± 0. 2） mm compared with（ 4. 1 ±0. 2） mm for fractured or loosened screws,（ 4. 1 ± 0. 3） mm for removed screws,the tibiofibular clear space was narrowed in patients with intact screws compared with removed,fractured or loosened screws（ P〈0. 05）. There was no difference in comparing fractured or loosened with removed screws（ P〉0. 05）. There were no differences in outcome comparing tibiofibular overlap and medial clear space（ P〉0. 05）,as well as large and small fragment screws. Conclusions An intact syndesmosis screw is associated with a worse functional outcome compared with loose,fractured,or removed screws. It is unlikely to a

关 键 词：联合螺钉固定 踝骨折 螺钉取出 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]