金属与可吸收螺钉固定下胫腓联合损伤比较  

Comparison of metallic screw and bioabsorbable screw for internal fixation of syndesmotic injury

作　　者：温晓东 鹿军 赵宏谋[1] 李毅[1] 梁晓军[1] WEN Xiaodong;LU Jun;ZHAO Hong-mou;LI Yi;LIANG Xiao-jun(Department of Foot and Ankle Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an 710054,China)

机构地区：[1]西安交通大学附属红会医院足踝外科,陕西西安710054

出　　处：《中国矫形外科杂志》2020年第8期676-681,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81301604)。

摘　　要：[目的]比较金属螺钉与可吸收螺钉治疗踝关节骨折合并下胫腓联合损伤的临床疗效。[方法]回顾性分析2014年10月~2017年9月82例踝关节骨折伴下胫腓联合损伤采用切复内固术患者的临床资料。采用随机数字表法分为两组,43例采用金属螺钉固定下胫腓联合,39例采用可吸收螺钉固定。比较两组患者的围手术期、随访和影像资料。[结果]两组患者手术顺利,未发生血管、神经损伤等严重术中并发症。金属螺钉组手术时间、术中出血量、透视时间、住院时间均优于可吸收螺钉组,虽然仅在手术时间的差异有统计学意义(P<0.05)。两组患者随访18~43月,平均(27.33±2.52)月。末次随访时与术后3个月比较,两组的AOFAS、OMA评分和踝关节ROM均显著增加,而VAS评分均显著降低(P<0.05)。术后3个月时,金属螺钉组的AOFAS评分、OMA评分和踝关节ROM显著小于可吸收螺钉组(P<0.05);末次随访时,两组间AOFAS、OMA、VAS评分和踝关节ROM的差异均无统计学意义(P>0.05)。影像方面,术后两组的TCS、MCS均较术前显著减少,TFO较术前显著增加,差异有统计学意义(P<0.05),相同时间点两组间在TCS、TFO、MCS的差异均无统计学意义(P>0.05)。术后CT显示,下胫腓复位不良率金属螺钉组为18.60%,可吸收螺钉组为5.13%,差异无统计学意义(P>0.05)。[结论]可吸收螺钉固定下胫腓联合损伤的疗效与传统金属螺钉相似,不需要二次手术取出,且下胫腓复位质量好。[Objective] To compare the clinical outcomes of internal fixations of syndesmotic disruption with metallic screw versus bioabsorbable screw. [Methods] A retrospective study was done on a total of 82 patients who underwent open reduction and internal fixation for ankle fractures accompanied with syndesmotic disruption form October 2014 to September 2017. Based on consequences of doctor-patient communication, 43 patients had the inferior syndesmosis fixed with traditional metallic screw, while the remaining 39 patients received syndesmotic fixation with absorbable screw. The perioperative, follow-up and radiographic documentations were compared between the two groups. [Results] All the patients underwent surgical procedures smoothly without grim complications, such as neurovascular injuries. The metallic screw group was superior to the absorbable screw group in operation time, intraoperative blood loss, radiation exposure time and hospital stay, although a statistical significance was proved in operation time only between them(P>0.05). The patients in both groups were followed up for 18~43 months with a mean of(27.33±2.52) months. The AOFAS, OMA scores and ankle ROM significantly increased, whereas the VAS score significantly decreased at the latest follow up in both group with comparison to those at 3 months postoperatively(P<0.05). The metallic screw group was significantly inferior to the absorbable screw group in AOFAS, OMA scores and ankle ROM at 3 months after operation(P<0.05), although there were no significant differences in any aforesaid parameters between them at the latest follow up(P>0.05). With respect to radiographic evaluation, the tibiofibular clear space(TCS), and medial clear space(MCS) significantly decreased, while the tibiofibular overlap(TFO) significantly increased after operation in both groups compared with those before operation(P<0.05), but no statistically significant differences were noticed between the two groups at any matching time point(P>0.05). The postoperative CT scans revealed

关 键 词：下胫腓联合损伤 切复内固定 金属螺钉 可吸收螺钉 

分 类 号：R683.42[医药卫生—骨科学]