[弹性固定与刚性固定治疗伴下胫腓联合损伤的踝关节旋前外旋骨折的疗效比较]
[Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis].
作者信息
Li Yuewei, Zhang Minghui, Li Xiaorong, Chen Xiaoyong, Deng Jianlong
机构信息
Department of Orthopedics, Chenggong Hospital (PLA No. 174) Affiliated to Xiamen University, Xiamen Fujian, 361000, P.R.China.
Department of Orthopedics, Chenggong Hospital (PLA No. 174) Affiliated to Xiamen University, Xiamen Fujian, 361000,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jul 15;31(7):820-824. doi: 10.7507/1002-1892.201702050.
OBJECTIVE
To compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis.
METHODS
A retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients (flexible fixation group) and cortical screw fixation in 27 patients (rigid fixation group). There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups ( >0.05). The operation time, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) score were compared between 2 groups.
RESULTS
The operation time was (83.0±9.1) minutes in the flexible fixation group and was (79.6±13.1) minutes in the rigid fixation group, showing no significant difference ( =1.052, =0.265). All patients achieved healing of incision by first intention. The patients were followed up 12-20 months (mean, 14 months). The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was (12.1±2.5) months in the flexible fixation group and was (11.3±3.2) months in the rigid fixation group, showing no significant difference between 2 groups ( =1.024, =0.192). Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups ( >0.05).
CONCLUSION
Suture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.
目的
比较弹性固定与刚性固定治疗合并下胫腓联合损伤的踝关节旋前外旋骨折的疗效。
方法
回顾性分析2013年1月至2015年12月期间收治的50例合并下胫腓联合损伤的踝关节旋前外旋骨折患者的临床资料。23例采用缝线纽扣固定（弹性固定组），27例采用皮质骨螺钉固定（刚性固定组）。两组患者在年龄、性别、体重、患侧、骨折类型以及受伤至手术时间等方面差异均无统计学意义（P>0.05）。比较两组患者的手术时间、内侧间隙（MCS）、胫腓间隙（TFCS）、胫腓重叠（TFO）、美国足踝外科协会（AOFAS）评分以及足踝功能障碍指数（FADI）评分。
结果
弹性固定组手术时间为（83.0±9.1）分钟，刚性固定组为（79.6±13.1）分钟，差异无统计学意义（t=1.052，P=0.265）。所有患者切口均一期愈合。患者随访12~20个月（平均14个月）。X线片显示两组骨折均愈合良好，均未出现螺钉断裂、延迟愈合或不愈合。弹性固定组骨折愈合时间为（12.1±2.5）个月，刚性固定组为（11.3±3.2）个月，两组比较差异无统计学意义（t=1.024，P=0.192）。刚性固定组有2例患者取出螺钉后出现复位丢失。末次随访时，两组MCS、TFCS、TFO、AOFAS评分及FADI评分差异均无统计学意义（P>0.05）。
结论
缝线纽扣固定与螺钉固定在踝关节功能及影像学表现方面疗效相似，且弹性固定在下胫腓联合复位丢失风险方面低于刚性固定。
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