Wen Xiaodong, Lu Jun, Zhao Hongmou, Li Yi, Chang Xin, Zhang Yan, Liang Jingqi, Liang Xiaojun
Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Apr 15;34(4):482-488. doi: 10.7507/1002-1892.201908118.
To compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture.
The clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups ( >0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded.
All patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups ( =1.229, =0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups ( =1.367, =0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] ( =1.549, =0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups ( =0.068, =0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up ( >0.05).
Compared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.
比较生物可吸收螺钉与金属螺钉治疗马松纽夫骨折的临床及影像学疗效。
回顾性分析2012年10月至2016年10月间68例行切开复位内固定治疗的马松纽夫骨折患者的临床资料。37例采用金属螺钉固定（A组），31例采用可吸收螺钉固定（B组）。两组在年龄、性别、体重、手术侧、受伤原因、受伤至手术时间及并发症方面差异无统计学意义（P>0.05）。末次随访时，记录胫腓间隙（TFCS）、胫腓重叠（TFO）、内侧间隙（MCS）及下胫腓联合复位不良率。并记录背伸和跖屈活动范围、疼痛视觉模拟评分（VAS）、美国足踝外科协会（AOFAS）的踝关节及后足评分以及奥勒鲁德 - 莫兰德（OM）评分。
所有患者均随访25 - 43个月，平均32.3个月。两组手术时间差异无统计学意义（t = 1.229，P = 0.282）。所有骨折均愈合，两组骨折愈合时间差异无统计学意义（t = 1.367，P = 0.413）。末次随访时，A组下胫腓联合复位不良率为16.2%（6/37），与B组[6.2%（2/31）]相比差异无统计学意义（Z = 1.549，P = 0.213）。A组有3例并发症，1例为浅表伤口感染，1例因未及时取出螺钉导致局部异位骨化，1例为螺钉局部异位骨化；B组有2例并发症，1例为排斥反应，1例为螺钉局部异位骨化。两组并发症发生率差异无统计学意义（Z = 0.068，P = 0.794）。末次随访时，两组在TFCS、MCS、TFO、踝关节背伸和跖屈活动范围、AOFAS评分、OM评分及VAS评分方面差异无统计学意义（P>0.05）。
与金属螺钉相比，可吸收螺钉能提供足够的固定和功能恢复，避免了螺钉取出且降低了下胫腓联合复位不良的发生率。
