新型下胫腓联合弹性钩钢板与Suture-button技术治疗下胫腓联合损伤的疗效比较  

Comparison of elastic syndesmosis hook plate and suture-button technique in treatment of syndesmosis injury

作　　者：林伟煌 刘庆军[1] 缪建云[1] 林需枰 丁真奇[1] 陈宏斌 林万昌 Lin Weihuang;Liu Qingjun;Miao Jianyun;Lin Xuping;Ding Zhenqi;Chen Hongbin;Lin Wanchang(Military Orthopaedic Center,909 Hospital of Joint Service Support Force of PLA(Dongnan Hospital Affiliated to Xiamen University),Zhangzhou 363000,Fujian,China)

机构地区：[1]解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)全军骨科中心,福建省漳州市363000

出　　处：《中华创伤骨科杂志》2021年第4期299-305,共7页Chinese Journal of Orthopaedic Trauma

基　　金：原南京军区医学科技创新课题(11MA078);军队卫勤保障能力创新与生成专项计划(21WQ043)。

摘　　要：目的比较新型下胫腓联合弹性钩钢板(ESHP)与Suture-button技术治疗下胫腓联合损伤的疗效。方法回顾性研究解放军联勤保障部队第九〇九医院全军骨科中心2013年3月至2017年3月收治的53例下胫腓联合损伤合并踝关节骨折患者资料,根据下胫腓联合固定方式不同分为ESHP组和Suture-button组。ESHP组:28例,男15例,女13例;年龄26~60岁;采用新型ESHP固定。Suture-button组:25例,男14例,女11例;年龄24~59岁;采用Suture-button技术固定。比较两组患者的固定下胫腓联合时间、术后切口引流量、住院时间,术后3、6、12个月比较踝关节最大跖屈、背伸角度、Baird-Jackson评分,观察并发症的发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。53例患者均顺利完成手术。ESHP组患者固定下胫腓联合的时间[(9.7±2.2)min]、术后切口引流量[(49.3±10.4)mL]显著少于Suture-button组[(16.2±1.4)min、(62.4±6.3)mL],术后3个月的最大跖屈角度(29.9°±1.3°)、Baird-Jackson评分(87.2±2.9)分显著大于Suture-button组[22.8°±1.3°、(78.7±4.1)分],差异均有统计学意义(P<0.05);两组患者的住院时间、术后6、12个月的最大跖屈角度,术后3、6、12个月的最大背伸角度,术后6、12个月的Baird-Jackson评分比较差异均无统计学意义(P>0.05)。所有患者均获随访,时间12~14个月(平均12.5个月)。所有患者随访期间骨折均愈合,于术后1年左右取出踝关节所有内固定物。随访1年内ESHP组出现1例因金属疲劳导致的内固定物失效。Suture-button组出现1例内固定物激惹,2例内固定物失效,1例内固定装置下沉和骨溶解。结论采用ESHP治疗下胫腓联合损伤比Suture-button技术具有更短的手术时间、更少的术后出血量和并发症,且更快地恢复踝关节功能。Objective To compare our self-designed elastic syndesmosis hook plate(ESHP)and suture-button technique in treatment of injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 53 patients who had been treated at Military Orthopaedic Center,909 Hospital of Joint Service Support Force of PLA for ankle fractures complicated with syndesmosis injury by ESHP or suture-button technique from March 2013 to March 2017.Of them,28 were treated by ESHP(ESHP group:15 males and 13 females aged from 26 to 60 years)and 25 by suture-button technique(suture-button group:14 males and 11 females aged from 24 to 59 years).The 2 groups were compared in terms of syndesmosis fixation time,postoperative incision bleeding,hospital stay,and ankle dorsiflexion and plantarflexion and ankle function by Baird-Jackson scoring at 3,6,12 months after surgery.Postoperative complications were observed.Results The 2 groups were comparable because there was no statistically significant deference in general data between the 2 groups(P>0.05).Surgery went on uneventfully in all the patients.The syndesmosis fixation time[(9.7±2.2)min]and postoperative incision bleeding[(49.3±10.4)mL]in the ESHP group were significantly less than in the suture-button group[(16.2±1.4)min and(62.4±6.3)mL](P<0.05);the maximum plantar flexion(29.9°±1.3°)and Baird-Jackson scores(87.2±2.9)at 3 months after surgery in the ESHP group were significantly greater than in the suture-button group(22.8°±1.3°and 78.7±4.1)(P<0.05).There were no significant differences between the 2 groups in hospital stay,maximum plantar flexion at postoperative 6 or 12 months,maximum dorsiflexion at postoperative 3,6 or 12 months,or Baird-Jackson scores at postoperative 6 or 12 months(all P>0.05).This cohort was followed up for 12 to 14 months(average,12.5 months).All fractures united during follow-up and all the implants were removed around postoperative 12 months.Follow-up within 12 months observed internal fixation failure caused by metal fatigue in

关 键 词：踝关节 骨折固定术 内 关节韧带 下胫腓联合 骨板 

分 类 号：R687.3[医药卫生—骨科学]