旋后-外旋型踝关节骨折的下胫腓固定：一项前瞻性随机研究。

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

作者信息

Kortekangas Tero H J, Pakarinen Harri J, Savola Olli, Niinimäki Jaakko, Lepojärvi Sannamari, Ohtonen Pasi, Flinkkilä Tapio, Ristiniemi Jukka

机构信息

Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland

Division of Orthopedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.

出版信息

Foot Ankle Int. 2014 Oct;35(10):988-95. doi: 10.1177/1071100714540894. Epub 2014 Jun 24.

DOI:10.1177/1071100714540894

PMID:24962527

Abstract

BACKGROUND

This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis.

METHODS

A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. The patients were randomized to either syndesmotic screw fixation (13 patients) or no syndesmotic fixation (11 patients). After a minimum of 4 years of follow-up (mean, 58 months), ankle function and pain (Olerud-Molander, a 100-mm visual analogue scale [VAS] for ankle function and pain) and quality of life (RAND-36) of all 24 patients were assessed. Ankle joint congruity and osteoarthritis were assessed using mortise and lateral projection plain weight-bearing radiographs and magnetic resonance imaging (MRI; 3T) scans.

RESULTS

Improvement in Olerud-Molander score, VAS, and RAND-36 showed no significant difference between groups during the follow-up. In the syndesmotic transfixation group, improvements in all functional parameters and pain measurements were not significant, whereas in the group without syndesmotic fixation, the Olerud-Molander score improved from 84 to 93 (P = .007) and the pain (VAS) score improved from 11 to 4 (P = .038) from 1 year to last follow-up. X-ray or MRI imaging showed no difference between groups at the last follow-up visit.

CONCLUSION

With the numbers available, no significant difference in functional outcome or radiologic findings could be detected between syndesmosis transfixation and no-fixation patients with SER IV ankle fracture after a minimum of 4 years of follow-up.

LEVEL OF EVIDENCE

Level II, prospective comparative study.

摘要

背景

本研究比较了在旋后外旋（SER）型踝关节骨折且术中证实下胫腓联合损伤的情况下，下胫腓联合固定与不固定的中期功能和影像学结果。我们的假设是，早期良好的功能结果将得以维持，且SER IV型踝关节骨折中未固定的下胫腓联合损伤不会导致骨关节炎发病率增加。

方法

对140例接受手术治疗的Lauge-Hansen SER IV（Weber B）型踝关节骨折患者进行了一项前瞻性研究。在进行骨折固定后，在透视下对双踝进行7.5 N·m的标准化外旋应力试验。应力检查阳性定义为在踝关节正位X线片上胫距或胫腓间隙两侧相差超过2 mm。患者被随机分为下胫腓联合螺钉固定组（13例）或不进行下胫腓联合固定组（11例）。在至少随访4年（平均58个月）后，评估了所有24例患者的踝关节功能、疼痛（Olerud-Molander评分，采用100 mm视觉模拟量表[VAS]评估踝关节功能和疼痛）以及生活质量（RAND-36）。使用踝关节正位和侧位负重X线片以及磁共振成像（MRI；3T）扫描评估踝关节的一致性和骨关节炎情况。

结果

在随访期间，两组间Olerud-Molander评分、VAS评分和RAND-36评分的改善情况无显著差异。在下胫腓联合固定组中，所有功能参数和疼痛测量指标的改善均不显著，而在未进行下胫腓联合固定组中，从1年到最后一次随访，Olerud-Molander评分从84提高到93（P = 0.007），疼痛（VAS）评分从11降低到4（P = 0.038）。在最后一次随访时，X线或MRI成像显示两组间无差异。