Ray Robbie, Koohnejad Nina, Clement Nick D, Keenan Gary F
Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Department of Orthopaedics, Inverclyde Royal Hospital Greenock, United Kingdom.
Foot Ankle Surg. 2019 Apr;25(2):180-185. doi: 10.1016/j.fas.2017.10.005. Epub 2017 Oct 28.
The primary aim of this study was to present the incidence of clinically significant end stage osteoarthritis (cOA) after syndesmotic fixation of ankle fractures. The secondary aim was to and identify independent predictors of cOA.
A retrospective review of consecutive patients presenting to a single University affiliated institution between March 2008 and May 2010 was undertaken. Inclusion criteria were ankle fractures with syndesmotic stabilisation. Patients were excluded if pre or postoperative radiographs were missing or were lost to follow up. Data were gathered regarding demographics, fracture pattern, fixation methods, reduction parameters, screw removal, revision surgery, complications and cOA up to seven years post injury.
Data were available for 120 patients (86%). In total, 13 patients (11%) developed cOA. Univariate analysis showed that increasing age, open fracture, malreduction of the syndesmosis, removal of symptomatic screws, revision surgery and complications were predictors of developing cOA. Cox regression analysis revealed increasing age (hazard ratio (HR) 1.09, p=0.006), and malreduction (HR 45.5, p=0.001) were independent predictors of developing cOA.
Ankle fractures with syndesmotic stabilisation represent a severe injury with a high rate of cOA. The only modifiable risk factor for developing cOA in this large series of patients was radiological malalignment. When syndesmotic stabilisation is required, careful intraoperative assessment should be undertaken to ensure the syndesmosis is reduced.
本研究的主要目的是呈现踝关节骨折下胫腓联合固定术后具有临床意义的终末期骨关节炎（cOA）的发生率。次要目的是确定cOA的独立预测因素。
对2008年3月至2010年5月期间在一家大学附属医院连续就诊的患者进行回顾性研究。纳入标准为伴有下胫腓联合稳定的踝关节骨折。如果术前或术后X线片缺失或患者失访，则将其排除。收集了有关人口统计学、骨折类型、固定方法、复位参数、螺钉取出、翻修手术、并发症以及受伤后长达七年的cOA的数据。
有120例患者（86%）的数据可用。总共有13例患者（11%）发生了cOA。单因素分析表明，年龄增加、开放性骨折、下胫腓联合复位不良、取出有症状的螺钉、翻修手术和并发症是发生cOA的预测因素。Cox回归分析显示，年龄增加（风险比（HR）1.09，p = 0.006）和复位不良（HR 45.5，p = 0.001）是发生cOA的独立预测因素。
伴有下胫腓联合稳定的踝关节骨折是一种严重损伤，cOA发生率很高。在这一大组患者中，发生cOA的唯一可改变风险因素是放射学对线不良。当需要进行下胫腓联合稳定时，应在术中进行仔细评估，以确保下胫腓联合得到复位。
