Kołodziej Łukasz, Kaczmarczyk Marek, Bohatyrewicz Andrzej, Budzyński Tomasz
Klinika Ortopedii i Traumotologii, Pomorska Akademia Medyczna w Szczecinie.
Chir Narzadow Ruchu Ortop Pol. 2010 May-Jun;75(3):143-6.
The routine procedure in cases with distal tibio-fibular syndesmotic ruptures associated with ankle fracture, is temporary fixation with a screw which is usually removed after a period considered long enough for the healing of torn syndesmotic ligaments. This ussualy requires need for a second hospitalization and generates additional costs for the health care system. The potential advantege of removing the syndesmotic stabilization is often questioned.
Aim of this study is to compare the clinical results of surgical treatment of ankle fractures with concomitant syndesmosis injury in patients where where syndesmotic screw was remowed before starting weightbearing and left intact.
In 33 patients treated surgically between 2006-2007 distal tibiofibular syndesmosis injury associated with ankle fractures was diagnosed and fixed with syndesmotic screw. In 13 patients, after average 14 weeks (from 7 to 22 weeks) syndesmotic screw was remowed and in 20 cases left intact. In 8 patients screw broke after full weightbearing was started. The average follow up period was 37 months. For the evaluation of treatment AOFAS hind-foot score (American Orthopedic Foot and Ankle Society) was used.
The mean AOFAS score for patients with remowed syndesmotic screw was 89 points while in groups where there was a spontaneous fracture of the screw or screw was left intact the results were respectively 85 and 87 points and did not differ significantly between groups.
The removal of syndesmotic stabilization before weightbearing does not significantly improve the outcome of operative treatment of ankle fractures with syndesmosis injury.
对于伴有踝关节骨折的胫腓下联合韧带断裂病例，常规做法是用螺钉进行临时固定，通常在认为撕裂的联合韧带愈合足够长的一段时间后取出螺钉。这通常需要再次住院，并给医疗系统带来额外费用。去除联合固定的潜在优势常常受到质疑。
本研究的目的是比较在开始负重前取出联合螺钉和保留联合螺钉的情况下，手术治疗伴有联合损伤的踝关节骨折患者的临床结果。
2006年至2007年期间，对33例接受手术治疗的患者诊断出伴有踝关节骨折的胫腓下联合损伤，并用联合螺钉进行固定。13例患者在平均14周（7至22周）后取出联合螺钉，20例患者保留螺钉。8例患者在开始完全负重后螺钉断裂。平均随访期为37个月。使用美国足踝外科协会（AOFAS）后足评分来评估治疗效果。
取出联合螺钉的患者平均AOFAS评分为89分，而螺钉自发断裂或保留螺钉的组的结果分别为85分和87分，两组之间无显著差异。
在负重前去除联合固定并不能显著改善伴有联合损伤的踝关节骨折手术治疗的结果。
