Manjoo Ajay, Sanders David W, Tieszer Christina, MacLeod Mark D
Orthopedic Surgery, Victoria Hospital, University of Western Ontario, London, Ontario, Canada.
J Orthop Trauma. 2010 Jan;24(1):2-6. doi: 10.1097/BOT.0b013e3181a9f7a5.
OBJECTIVE: Screw fixation of the injured syndesmosis restores stability but may reduce motion. The purpose of this study is to determine whether functional outcomes and radiographic results after ankle fracture are affected by the status of the syndesmosis screw. DESIGN: Retrospective review of a consecutive clinical series. SETTING: Level 1 academic trauma center. PATIENTS: One hundred six adults were reviewed radiographically; mean follow up was 15 months (range, 4-30 months). Seventy-six of the 106 patients completed formal functional testing; mean follow up was 23 +/- 13 months (range, 12-32 months). INTERVENTION: Open reduction and internal fixation, including fixation of the tibiofibular syndesmosis. MAIN OUTCOME MEASUREMENTS: Patients with intact, broken or loose, or removed syndesmosis screws were compared. Functional outcomes were measured using the Lower Extremity Measure and the Olerud Molander ankle score. Radiologic review included tibiofibular clear space, tibiofibular overlap, and medial clear space. RESULTS: Functional outcomes were improved in patients with fractured, loosened, or removed screws compared with those with intact screws. The Lower Extremity Measure score for patients with intact screws was 70 +/- 6 compared with 85 +/- 3 for fractured, loosened, or removed screws (P = 0.01). The Olerud Molander ankle score for patients with intact screws was 47 +/- 8.0 compared with 64 +/- 4 for fractured, loosened, or removed screws (P = 0.04). There was no difference in outcome comparing fractured, loosened, and removed screws. The tibiofibular clear space was narrowed in patients with intact screws compared with removed, fractured, or loose screws. The tibiofibular clear space for intact screws was 3.1 +/- 0.2 compared with 4.1 +/- 0.2 for removed, fractured, or loosened screws (P = 0.005). There was no difference in outcome comparing large and small fragment screws. CONCLUSIONS: An intact syndesmosis screw was associated with a worse functional outcome compared with loose, fractured, or removed screws. However, there were no differences in functional outcomes comparing loose or fractured screws with removed screws. Screw removal is unlikely to benefit patients with loose or fractured screws but may be indicated in patients with intact syndesmosis screws.
目的：对损伤的下胫腓联合进行螺钉固定可恢复稳定性，但可能会减少活动度。本研究的目的是确定下胫腓联合螺钉的状态是否会影响踝关节骨折后的功能结局和影像学结果。 设计：对连续临床系列进行回顾性研究。 地点：一级学术创伤中心。 患者：对106名成年人进行了影像学检查；平均随访时间为15个月（范围4 - 30个月）。106名患者中有76名完成了正式的功能测试；平均随访时间为23±13个月（范围12 - 32个月）。 干预：切开复位内固定，包括胫腓联合固定。 主要观察指标：比较下胫腓联合螺钉完整、断裂或松动、取出的患者。使用下肢测量和奥勒鲁德 - 莫兰德踝关节评分来评估功能结局。影像学评估包括胫腓间隙、胫腓重叠和内侧间隙。 结果：与螺钉完整的患者相比，螺钉断裂、松动或取出的患者功能结局有所改善。螺钉完整的患者下肢测量评分为70±6，而螺钉断裂、松动或取出的患者为 85±3（P = 0.01）。螺钉完整的患者奥勒鲁德 - 莫兰德踝关节评分为47±8.0，而螺钉断裂、松动或取出的患者为64±4（P = 0.04）。比较螺钉断裂、松动和取出的情况，结局无差异。与螺钉取出、断裂或松动的患者相比，螺钉完整的患者胫腓间隙变窄。螺钉完整的患者胫腓间隙为3.1±0.2，而螺钉取出、断裂或松动的患者为4.1±0.2（P = 0.005）。比较大碎片螺钉和小碎片螺钉，结局无差异。 结论：与螺钉松动、断裂或取出相比，下胫腓联合螺钉完整与较差的功能结局相关。然而，比较螺钉松动或断裂与取出的情况，功能结局无差异。取出螺钉不太可能使螺钉松动或断裂的患者受益，但对于下胫腓联合螺钉完整的患者可能有必要。
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