CT评估踝关节骨折螺钉内固定后的下胫腓联合复位情况  

Tibiofibular syndesmosis reduction after screw fixation of ankle fracture evaluated by CT imaging

作　　者：王栋 曾德斌[2] 林乔 刘克辉 Wang Dong;Zeng Debin;Lin Qiao;Liu Kehui(Department of Orthopedics,Fifth People’s Hospital of Hainan Province,Haikou 571127,Hainan Province,China;Department of Orthopedics,Hainan General Hospital,Haikou 570206,Hainan Province,China;Department of Radiology,Haikou People’s Hospital,Haikou 570208,Hainan Province,China)

机构地区：[1]海南省第五人民医院骨科,海南省海口市571127 [2]海南省人民医院骨科,海南省海口市570206 [3]海口市人民医院放射科,海南省海口市570208

出　　处：《中国组织工程研究》2020年第33期5349-5353,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:评估胫腓骨韧带联合的解剖复位对于踝关节骨折的手术治疗十分重要,而研究中复位不良发生率的巨大差异可能是由于对复位不良的测量方法和定义不一致造成的。目的:观察踝关节骨折螺钉固定术后和螺钉取出后1年下胫腓联合复位随时间的变化情况,并评估下胫腓联合复位不良的发生率。方法:纳入29例接受胫腓骨螺钉固定的踝关节骨折患者,在骨折手术6周后取出下胫腓联合螺钉。使用CT扫描图像评估在骨折术后2周内和螺钉取出后1年的下胫腓复位情况;测量两侧胫腓骨前后距离的差异,以及前后腓骨平移和腓骨旋转情况。结果与结论:①患者联合固定术后平均前胫腓距离为(0.8±1.4) mm,螺钉移除后1年增加到(1.8±1.1) mm,差异有显著性意义(P=0.001);②在下胫腓联合固定术后,4例踝关节前胫腓骨距离复位不良,其中3例增宽,1例过紧;在螺钉取出后1年时间里,有8例踝关节复位不良,所有韧带联合都在扩大;其他测量值不随时间而变化;③不同复位不良定义方法下,联合固定术后复位不良的发生率为10%-51%,螺钉取出后1年发生率为20%-62%,此次研究与其他学者的结论相比差异均有显著性意义(P=0.01,0.03);④提示在取出胫腓螺钉后1年内,前胫腓距离变宽,而其他方向的平移和旋转差异不大;不同观察者测量的重复性良好,不同的测量方法会导致复位不良的发生率有差异。BACKGROUND: Assessing tibiofibular ligament combined anatomical reduction is important for the surgical treatment of ankle fractures, and the large difference in the incidence of malreduction in the study may be due to inconsistent measurement and definition of malreduction. OBJECTIVE: To observe the changes of tibiofibular joint reduction over time 1 year after tibiofibular joint screw fixation and screw removal for ankle fractures, and to evaluate the incidence of poor tibiofibular joint reduction. METHODS: Twenty-nine patients with tibiofibular screw fixation for ankle fractures were evaluated. The lower tibiofibular joint screw was removed 6 weeks after fracture surgery. CT scan images were used to evaluate the reduction of the lower tibiofibular region within two weeks after fracture surgery and one year after screw removal. The differences of the anterior and posterior distances of the tibiofibula, anteroposterior fibula translation, and fibular rotation were measured. RESULTS AND CONCLUSION:(1) The mean anterior tibiofibular distance after combined fixation was(0.8±1.4) mm, and increased to(1.8±1.1) mm within 1 year after screw removal(P=0.001).(2) After the combined fixation of the lower tibiofibular joint, the anterior tibiofibular distance of the ankle joint was maladjusted in four cases, among which three cases had the ankle joint widened and one case had the ankle joint too tight. In one year, there were eight cases of malreduction of the ankle joint and all of the ankle joints were enlarged. Other measurements did not change over time.(3) According to the definition of poor reduction, the incidence of poor reduction after lower tibiofibular joint fixation was 10%-51%, and the incidence of poor reduction was 20%-62% 1 year after screw removal. The difference in the incidence of poor reduction was statistically significant(P=0.01, 0.03).(4) It is indicated that within 1 year after removal of the tibiofibular screw, the anterior tibiofibular distance widened, but there was no significant difference in

关 键 词：骨 踝 关节 骨折 内固定 CT 胫腓联合 韧带 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]