前后联合直视下复位治疗新鲜下胫腓联合损伤  

Reduction under direct vision through anterior and posterior approaches for acute syndesmosis injuries

作　　者：郑建平[1] 秦悦 杨海波[1] ZHENG Jian-ping;QIN Yue;YANG Hai-bo(Orthopaedic Department,General Hospital,Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院创伤骨科,宁夏银川750004

出　　处：《中国矫形外科杂志》2020年第6期490-495,共6页Orthopedic Journal of China

摘　　要：[目的]探讨前、后联合直视下复位治疗Dannis-Weber C型踝关节骨折中新鲜的下胫腓联合损伤的临床疗效。[方法]回顾性分析本科收治的85例Dannis-Weber C型踝关节骨折,所有下胫腓联合损伤均为新鲜损伤。依据下胫腓前间隙是否被切开直视下复位将患者分为两组,其中直视复位组42例,常规复位组43例。对比两组患者围手术期资料、美国足踝外科协会(AOFAS)踝-后足评分,疼痛视觉模拟评分(VAS)和影像评估下胫腓复位情况。[结果]两组患者均顺利手术,直视复位组3例患者出现后踝骨折复位不满意致使下胫腓不能精准复位,术中通过切开下胫腓前间隙辅助复位直到满意;常规组有3例患者术中出现固定后踝骨块的钉板放置不满意,术中予以纠正。两组患者随访24~31个月,平均(26.14±1.48)个月。直视复位组开始负重时间近似于常规复位组,差异无统计学意义(P>0.05);直视复位组完全负重时间明显早于常规复位组,差异有统计学意义(P<0.05)。末次随访时,两组患者AOFAS评分均较术前显著增加(P<0.05);而两组的VAS评分均显著降低(P<0.05)。术前两组间ASFAS和VAS评分的差异均无统计学意义(P>0.05),但末次随访时直视复位组的AOFAS和VAS评分均显著优于常规复位组(P<0.05)。影像评估方面:直观组复位不良率为7.14%(3/42),而常规复位组为33.33%(15/45),差异有统计学意义(P<0.05)。至末次随访时,直视复位组发生踝关节炎1例,而常规复位组6例,但差异无统计学意义(P>0.05)。Spearman秩相关分析表明:复位不良累及的平面数与AOFAS评分呈负相关(R=-0.878,P<0.001)。[结论]下胫腓复位质量与功能恢复密切相关,直视下复位手术治疗Dannis-Weber C型踝关节骨折的下胫腓联合损伤可明显提升复位质量。[Objective]To explore clinical outcomes of reduction under direct vision through anterior and posterior ap proach for acute syndesmosis injuries in Dannis-Weber type C ankle fractures.[Methods]A retrospective study was done on 85 patients who underwent open reduction and internal fixation(ORIF)for acute syndesmosis injury in Dannis-Weber type C ankle fracture.According to whether or not the tibiofibular clear space exposed,42 patients had reduction conducted under direct vi sion,while the remaining 43 patients got reduction by conventional technique.The perioperative data,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,visual analogue scale(VAS)for pain,the rate of malreduction and the rate of ankle arthritis measured in images were compared between two groups.[Results]All the patients in both groups had oper ation performed successfully with no serious complication,and followed up for 24~31 months with a mean of(26.14±1.48)months.There were no significant difference between the two groups regarding the time of returning to partial weight bearing(P>0.05),but the patients in the direct vision group returned to complete weight bearing significantly earlier than those in the con ventional group(P<0.05).The AOFAS scores significantly increased,whereas VAS scores significantly decreased in both groups at the latest follow up in contrast to those before operation(P<0.05).The direct vision group proved significantly superi or to the conventional group in the AOFAS and VAS scores at the latest follow up(P<0.05),regardless of no statistical differenc es between two groups in aforesaid parameters before operation(P>0.05).In respect to radiographic assessment,the malreduc tion rate was of 7.14%(3/42)in the direct vision group,where as 33.33%(15/45)in the conventional group,which proved statistically significant(P<0.05).To the latest follow up,ankle arthritis was noted in 1 patient of the direct vision group only,whereas 6 patients in the conventional group,without a statisti cally significant differe

关 键 词：下胫腓联合损伤 直视 前后入路 复位 

分 类 号：R683.42[医药卫生—骨科学]