摘要
[目的]比较免打结锁扣带袢钢板(Knotless TightRope)与螺钉固定治疗下胫腓联合损伤伴踝关节骨折的临床效果。[方法]2015年8月~2016年12月本科收治33例下胫腓联合损伤合并踝关节骨折患者。依照下胫腓固定方法,15例采用TightRope固定,18例采用3枚皮质螺钉固定。采用AOFAS踝与后足功能评分及术侧与健侧踝关节活动度平均差值等比较两组临床效果。[结果]所有患者均顺利手术,无血管神经损伤等严重并发症。所有病例随访12~15个月,平均(13.62±1.46)个月。随着术后时间延长,两组的AOFAS评分均显著增加,各组不同时间点间的差异均有统计学意义(P<0.05);但术后3、6、12个月时,两组间AOFAS评分差异均无统计学意义(P>0.05)。而随着术后时间延长,两组的双侧踝关节活动度差值均显著减少,各组不同时间点间的差异均有统计学意义(P<0.05);术后3、6、12个月时,TightRope组双侧踝关节活动度差值均显著小于螺钉组,差异均有统计学意义(P<0.05)。术后2个月,螺钉固定组出现断钉1例,改行TightRope固定,至末次随访时,下胫腓联合无分离,功能恢复良好。[结论]锁扣带袢钢板与螺钉均可有效固定下胫腓联合。相比之下,锁扣带袢钢板具有患者可早期负重锻炼、关节活动度恢复良好、术后无需常规取出内置物的优势。
[Objective] To compare the clinical outcomes of knotless TightRope versus tricortical screw for distal tibiofibular syndesmotic injuries accompanied with complex ankle fractures. [Methods] From August 2015 to December 2016, 33 patients underwent surgical treatment for distal tibiofibular syndesmotic injuries accompanied with complex ankle fractures in our department. In term of the internal fixation of distal tibiofibular syndesmosis, 15 patients had the syndesmosis fixed with TightRope, while 18 patients got fixation with a tricortical screw. The AOFAS score and the difference of ankle range of motion（ROM） between the unaffected side and affected side were applied for evaluation of the clinical outcomes. [Results] All the patients underwent operation smoothly without serious complications, such as neurovascular injuries. All of them were followed up for 12 to 15 months with an average of（13.62±1.46） months. The AOFAS score statistically significantly increased in both groups over time（P〈0.05）, although no statistical difference was noticed at 3, 6 and 12 months postoperatively between the two groups（P〉0.05）. In addition, the difference of ROM between the affected and unaffected sides statistically significantly decreased as time went on（P〈0.05）. The TightRope group had significant less the difference of ROM between both sides than the screw group at 3, 6 and 12 months postoperatively（P〈0.05）. At 2 months after operation, 1 patient in the screw group had screw broken, which was turned to internal fixation with the TightRope, and got satisfactory functional recovery without syndesmotic separation at the latest follow up. [Conclusion] Both TightRope and tricortical screw are effective fixation for distal tibiofibular syndesmotic injuries. By comparison, the TightRope takes advantages of facilitation of early motion, and improved ROM and no need for the implant removal.
作者
李建鹏
陈玉宏
尹梦帆
王松
张田宇
高翔
LI Jian-peng;CHEN Yu-hong;YIN Meng-fan;WANG Song;ZHANG Tian-yu;GAO Xiang(Depart-ment of Orthopaedics,The Fifth Central Hospital of Tianjin City,Tianjin 300450,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第18期1648-1652,共5页
Orthopedic Journal of China
基金
2017年天津市滨海新区卫生计生委科技项目(编号:2017BWKY036)
作者简介
李建鹏，主治医师，医学硕士，研究方向：创伤骨科，（电话）13821229042，（电子信箱）ljianpeng1006@126.com;通信作者：高翔，（电话）18602680855，（电子信箱）tjwzxgx@126.com
