2种不同手术方法治疗陈旧性踝关节骨折合并下胫腓联合损伤的对比  

Comparison of Two Surgical Managements for the Delayed Ankles Fracture Combined with Distal Tibiofibular Syndesmosis Injuries

作　　者：刘路平[1] 朱兰然 张卫 陈磊杰[1] 王超然[1] 廖经武[3] LIU Lu-ping;ZHU Lan-ran;ZHANG Wei;CHEN Lei-jie;WANG Chao-ran;LIAO Jing-wu(Dept,of Orthopedic Surgery,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101;Second Department of Surgery,Luchun County People fs Hospital,Luchun Honghe Prefecture 662500;Orthopedic-Traumatology Department,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院骨科,云南昆明650101 [2]绿春县人民医院外二科,云南绿春662500 [3]昆明医科大学第二附属医院创伤外科,云南昆明650101

出　　处：《昆明医科大学学报》2021年第10期106-111,共6页Journal of Kunming Medical University

基　　金：云南省教育厅-昆明医科大学应用基础研究联合专项基金资助项目[202001AY070001(-066)]。

摘　　要：目的探讨陈旧性踝关节骨折合并下胫腓联合韧带损伤(ankles fracture combined with distal tibiofibular syndesmosis injuries,AFTSI)的手术治疗效果。方法回顾性分析38例陈旧性AFTSI手术疗效,患者受伤至手术时间28~196 d,平均53 d。其中切开复位内固定+下胫腓联合Tighttrope袢钢板弹性固定18例(A组,n=18),切开复位内固定+下胫腓联合螺钉固定20例(B组,n=20),术后美国足踝外科学会评分、手术前后下胫腓间隙及下胫腓重叠阴影差值,平均住院时间,手术时间,术中失血量,术后开始完全负重时间用于评价疗效。所有患者均接受平均18个月随访,下胫腓联合螺钉于术后2~3月取出。结果所有患者均未出现切口感染、骨性关节炎、内固定断裂及踝穴增宽情况;术后AOFAS评分A组高于B组,术后开始完全负重时间A组早于B组(P<0.05);平均手术时间,术中失血量,平均住院时间,手术前后下胫腓重叠阴影差值及下胫腓间隙差值2组差异无统计学意义(P>0.05)。结论陈旧性AFTSI使用Tightrope袢钢板弹性固定患者可以早期负重,较传统的螺钉内固定具有更好的疗效。Objective To investigate the effect of surgical treatments for delayed ankles fracture combined with distal tibiofibular syndesmosis injuries(AFTSI).Methods A retrospective study the operative effects of 38 cases of delayed AFTSI treated with open reduction and internal fixation(ORIF)+Tightrope fixation(group A,n=18)or ORIF+screw fixation(group B,n=20)for syndesmosis injuries.AOFAS(Ankle-Hindfoot Score system),hospital stay,operative time,introperative blood loss,full weightbearing time,difference value between preoperative and postoperative tibiofibular clear space(TFCS)and tibiofibular overlap(TFO)were used to evaluate the postoperative curative effect.All patients were received a follow-up with an average of 18 months,and the syndesmosis screws were removed 2-3 months after operations.Results AOFAS score was higher in group A than in group B,postoperative onset time of full weightbearing was earlier in group A than in group B statistically(P<0.05),while no statistics difference were found between 2 groups in the factors of hospital stay,operative time,introperative blood loss,and the difference value between preoperative and postoperative time on TFCS together with TFO.Conclusion Tightrope syndesmosis fixation is a better options to enable early weight bearing for the delayed AFTSI compared with the traditional screws fixation.

关 键 词：陈旧性踝关节骨折 下胫腓联合损伤 手术治疗 弹性固定 

分 类 号：R683[医药卫生—骨科学]