下胫腓螺钉固定联合下胫腓韧带修复治疗踝关节骨折合并下胫腓联合损伤的疗效  

Curative effect of distal tibiofibular screw fixation combined with ligament repair for the treatment of ankle fracture accompanied with distal tibiofibular syndesmosis injuries

作　　者：林需枰 刘庆军[1] 丁真奇[1] 林斌[1] 林伟煌 谢玮娜[3] 涂承权 Lin Xuping;Liu Qingjun;Ding Zhenqi;Lin Bin;Lin Weihuang;Xie Weina;Tu Chengquan(Department of Orthopedics,909th Hospital of Joint Service Support Force of PLA(Affiliated Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;Department of Orthopedic Surgery,Xiamen Haicang Hospital,Xiamen 361100,China;Department of Anesthesiology,909th Hospital of Joint Service Support Force of PLA(Affiliated Dongnan Hospital of Xiamen University),Zhangzhou 363000,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)骨科,漳州363000 [2]厦门市海沧医院骨科,厦门361000 [3]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)麻醉科,漳州363000

出　　处：《中华创伤杂志》2022年第5期424-429,共6页Chinese Journal of Trauma

基　　金：军队卫勤保障能力创新与生成专项计划(21WQ043)。

摘　　要：目的探讨下胫腓螺钉固定联合下胫腓韧带修复治疗踝关节骨折合并下胫腓联合损伤的疗效。方法采用回顾性队列研究分析2017年9月至2020年9月联勤保障部队第九〇九医院收治的72例踝关节骨折合并下胫腓联合损伤患者临床资料,其中男38例,女34例;年龄19~65岁[(42.5±12.2)岁]。按Danis-Weber分型,B型30例,C1型29例,C2型13例。36例采用下胫腓螺钉固定联合下胫腓韧带修复治疗(固定+修复组),36例行下胫腓螺钉固定治疗(固定组)。比较两组手术时间、术中出血量、住院时间、术后1,3个月及末次随访时视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分、踝关节活动度(ROM)及并发症发生情况。结果患者均获随访12~22个月[(15.9±2.2)个月]。两组手术时间、术中出血量和住院时间差异无统计学意义(P均>0.05)。术后1,3个月固定+修复组VAS分别为(3.1±1.0)分和(2.1±0.6)分,低于固定组的(3.9±0.8)分和(2.6±0.8)分(P均<0.05),末次随访时两组VAS差异无统计学意义(P>0.05)。术后1,3个月及末次随访时固定+修复组AOFAS踝-后足评分别为(64.7±4.0)分、(73.2±3.4)分、(87.2±3.4)分,高于固定组的(60.1±4.9)分、(70.2±1.9)分、(84.1±2.6)分(P均<0.05)。术后1个月两组踝关节ROM差异无统计学意义(P>0.05),术后3个月及末次随访时固定+修复组踝关节ROM分别为(44.4±2.9)°和(52.3±2.5)°,大于固定组的(41.4±2.7)°和(50.1±2.7)°(P均<0.05)。固定+修复组发生内固定松动1例;固定组发生下胫腓关节再分离2例,内固定松动、断裂各2例。固定+修复组并发症发生率为3%(1/36),低于固定组的17%(6/36)(P<0.05)。结论与下胫腓螺钉固定比较,下胫腓螺钉固定联合下胫腓韧带修复治疗踝关节骨折合并下胫腓联合损伤能早期减轻术后疼痛,获得更好的踝关节功能及活动度恢复,并减少相关并发症发生。Objective To investigate the clinical efficacy of distal tibiofibular screw fixation combined with ligament repair for the treatment of ankle fracture accompanied with distal tibiofibular syndesmosis injuries.Methods A retrospective cohort analysis was made on clinical data of 72 patients with ankle fracture accompanied with distal tibiofibular syndesmosis injuries admitted to 909th Hospital of Joint Service Support Force of PLA from September 2017 to September 2020,including 38 males and 34 females,aged 19-65 years[(42.5±12.2)years].The fracture was type B in 30 patients,type C1 in 29 and type C2 in 13 according to Danis-Weber classification.A total of 36 patients were treated by distal tibiofibular screw fixation combined with ligament repair(fixation+repair group)and 24 patients by distal tibiofibular screw fixation(fixation group).Operation time,intraoperative blood loss and hospital stay were recorded.Visual analogue scale(VAS),American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot score and ankle range of motion(ROM)were determined at 1,3 months postoperatively and at the final follow-up.Complications were documented.Results All patients were followed up for 12-22 months[(15.9±2.2)months].There were no significant differences in operation time,intraoperative blood loss and hospital stay between the two groups(all P>0.05).VAS in fixation+repair group was(3.1±1.0)points and(2.1±0.6)points at 1,3 months postoperatively,significantly lower than(3.9±0.8)points and(2.6±0.8)points in fixation group(all P<0.05),but the score showed no significant difference between the two groups at the final follow-up(P>0.05).AOFAS score in fixation+repair group was(64.7±4.0)points,(73.2±3.4)points and(87.2±3.4)points at 1,3 months postoperatively and at the final follow-up,significantly higher than(60.1±4.9)points,(70.2±1.9)points and(84.1±2.6)points in fixation group(all P<0.05).There was no significant difference in the ROM between the two groups at 1 month postoperatively(P>0.05),but the ROM at 3 months po

关 键 词：踝损伤 骨折固定术 内 韧带 关节 

分 类 号：R687.3[医药卫生—骨科学]