Knotless TightRope在预防急性踝关节损伤合并下胫腓联合不稳导致异位骨化中的意义  

Knotless Tight Rope Treat the Acute Malleolus Syndesmosis Injury with Lower Tibiofibular Separation:A Clinical Randomized Controlled Trials Study

作　　者：蔡新宇[1] 郑龙坡[1] 茅凌洲[1] 楼列名[1] 李少华[1] 刘杰[1] 丛锐军[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《实用骨科杂志》2017年第6期511-515,共5页Journal of Practical Orthopaedics

基　　金：上海市科委基金(14DZ1941002)

摘　　要：目的急性下胫腓联合损伤治疗不当严重影响踝关节功能,不稳长期存在可继发胫腓间异位骨化,本试验旨在探讨Knotless TightRope缝合器治疗该疾病的临床疗效及异位骨化的发生与踝关节功能的关系。方法 56例急性下胫腓联合损伤合并分离,随机分为A组和B组。术前行踝关节三维CT检查。A组使用Knotless TightRope缝合器重建下胫腓联合。B组采用传统单根三皮质4.5 mm螺钉重建。术中行HOOK试验。随访24h、2周、3个月、12个月的VAS评分,AOFAS评分、SF-36评分和踝关节活动度,术后1周、3个月、1年踝关节摄片。记录深部感染等并发症发生率。计数资料采用卡方分析,方差齐的计量资料采用组间独立样本t检验的统计方法,P值为0.05。结果本组52例获随访,平均随访时间12个月。24h、2周的VAS评分、SF-36评分、AOFAS评分差异无统计学意义,术后3个月AOFAS评分A组为(88.2±16.4)分,B组为(76.6±13.6)分,差异有统计学意义,VAS评分、SF-36评分差异无统计学意义。术后12个月的VAS评分、AOFAS评分和SF-36评分A组分别为(2.1±2.4)分、(88.6±21.5)分和(92.2±8.6)分,B组分别为(5.1±3.2)分、(76.2±15.6)分和(86.4±9.8)分,差异有统计学意义。各组均出现3例皮肤延迟愈合。A组4例异位骨化,B组无异位骨化发生,差异有统计学意义,但与踝关节功能评分不相关,A组无再次胫腓分离发生,B组6例断钉后发生胫腓再次分离,组间卡方分析差异有统计学意义。结论较传统螺钉固定,Knotless TightRope缝合器治疗急性下胫腓联合损伤合并下胫腓分离的短期疗效较确切,具有固定不易断裂、无需再次手术取出、可早期负重锻炼等优点,较传统螺钉固定疗效更佳。需注意弹性固定本身存在异位骨化的风险,但这并不影响手术近期疗效与患者踝关节功能恢复。Objective To explore the clinical curative effect of Knotless TightRopein acute condylar syndesmosis injury complicated with tibiofibular separation.Methods 56 patients of acute condylar syndesmosis injury complicated with tibiofibular separation undergoing emergency surgery,who were divided into A group and B group randomly.All patients had 3-dimensional CT reconstruction of the malleolus.In A group Knotless Tight Rope were used and in B group tranditional 4.5 millimeter cannulated screw tricortical fixation were used.Suspected cases were check with HOOK test.Follow up schedule include 24th hour,2nd week,3rd and 12th month afteroperation.The observation target include VAS score,AOFAS score,SF-36 score.Posterior-anterior radiograph of ankle were taken 1st week 3rd month and 1st year.Complications were record.One way ANOVA,Chi-square test and t test were used for statistic.α value is defined as 0.05.Results 52 patient were followed up to 12th month.The AOFAS score on the 3rd month are （88.2±16.4） and （76.6±13.6） respectively and is of significant statistical difference.VAS score,AOFAS score and SF-36 score on the 12th month is of significant difference.There were no infection during the following up except 6 case of slow cicatrization of wound.There were 4 heterotopic ossification in A group.There were statisticallysignificant different.But there were no relationship between heterotopic ossification and ankle function.There were no re-separation in A group,breakage of cannulated screw occurred in 6 cases,there were significant statistical difference. Conclusion The Knotless Tight Rope is more appropriate for distal tibiofibular syndesmosis injury,how ever the higher rate of heterotopic ossification will not affect the ankle function.

关 键 词：下胫腓分离 异位骨化 Knotless TightRope缝合器 AOFAS评分 

分 类 号：R683.42[医药卫生—骨科学]