Wikerøy Annette K B, Høiness Per R, Andreassen Geir S, Hellund Johan C, Madsen Jan Erik
Orthopaedic Center, Ullevål University Hospital, Oslo, Norway.
J Orthop Trauma. 2010 Jan;24(1):17-23. doi: 10.1097/BOT.0b013e3181bedca1.
To assess long-term functional and radiologic results after two types of syndesmosis fixation, comparing one quadricortical syndesmotic screw fixation with two tricortical screw fixation in ankle fractures.
Follow up of a previously conducted prospective, randomized clinical study.
University clinic, Level I trauma center.
Forty-eight patients with closed ankle fractures and concomitant syndesmotic rupture were operated on with quadricortical (n = 23) or tricortical (n = 25) syndesmotic fixation.
Follow-up time was 8.4 years (range, 7.7-8.9 years). There were no statistical differences in the two groups regarding Olerud-Molander Ankle score, Orthopaedic Trauma Association score, or degree of osteoarthritis. Patients with a difference in the syndesmotic width between the operated and the nonoperated ankle of 1.5 mm or more showed a tendency toward poorer functional results (P = 0.056). Twenty-one patients showed synostosis on plain radiographs. Of these, only seven patients had synostosis verified on computed tomography, all of whom had significantly worse function. Patients with a posterior fracture fragment at time of operation had poorer Olerud-Molander Ankle score (73.1 versus 85, P = 0.05) and all had osteoarthritis as compared with 55% of those without a posterior fragment. Obese patients (body mass index greater than 30 kg/m2) also had poorer Orthopaedic Trauma Association score, but neither obesity nor being overweight predicted late arthritis.
Follow up 8.4 years after surgery of ankle fractures with syndesmotic injury showed satisfactory functional results with only minor differences between the two groups of syndesmotic fixation. Obese patients had significantly poorer functional results. The presence of a posterior fracture fragment was an important negative prognostic factor regarding functional results. Plain radiographs overestimated tibiofibular synostosis. Synostosis on computed tomography, however, predicted impaired ankle function. A difference in syndesmotic width 1.5 mm or greater between the two ankles seemed to be associated with an inferior clinical result.
评估两种下胫腓联合固定方式后的长期功能及影像学结果，比较单枚四层皮质下胫腓联合螺钉固定与两枚三层皮质螺钉固定在踝关节骨折中的应用。
对先前进行的一项前瞻性、随机临床研究的随访。
大学诊所，一级创伤中心。
48例闭合性踝关节骨折合并下胫腓联合损伤的患者接受了四层皮质（n = 23）或三层皮质（n = 25）下胫腓联合固定手术。
随访时间为8.4年（范围7.7 - 8.9年）。两组在Olerud-Molander踝关节评分、骨科创伤协会评分或骨关节炎程度方面无统计学差异。手术侧与非手术侧下胫腓联合宽度差异在1.5 mm及以上的患者，其功能结果有较差的趋势（P = 0.056）。21例患者在X线平片上显示有骨桥形成。其中，仅7例患者经计算机断层扫描证实有骨桥形成，所有这些患者的功能明显更差。手术时有后骨折块的患者Olerud-Molander踝关节评分较差（73.1对85，P = 0.05），且均有骨关节炎，而无后骨折块的患者中这一比例为55%。肥胖患者（体重指数大于30 kg/m²）的骨科创伤协会评分也较差，但肥胖和超重均不能预测晚期关节炎。
对合并下胫腓联合损伤的踝关节骨折术后8.4年的随访显示，功能结果令人满意，两组下胫腓联合固定方式之间仅有微小差异。肥胖患者功能结果明显较差。后骨折块的存在是影响功能结果的重要不良预后因素。X线平片高估了胫腓骨骨桥形成。然而，计算机断层扫描显示的骨桥形成预示踝关节功能受损。两侧下胫腓联合宽度差异1.5 mm及以上似乎与较差的临床结果相关。
