Yuan Xinwei, Zhang Bin, Hu Jiang, Lu Bing
Department of Orthopedics, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Aug 15;36(8):989-994. doi: 10.7507/1002-1892.202201101.
To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws.
A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups ( >0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness.
There was no significant difference in operation time between the two groups ( =-0.683, =0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups ( =-1.128, 0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation ( <0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation ( >0.05).
Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws.
比较金属螺钉与可吸收螺钉修复下胫腓联合损伤的短期疗效。
回顾性分析2017年1月至2020年1月收治的63例踝关节骨折合并下胫腓联合损伤患者的临床资料。其中31例采用可吸收螺钉固定下胫腓联合（研究组），32例采用金属螺钉固定下胫腓联合（对照组）。两组患者在性别、年龄、受伤原因、手术侧别、受伤至手术时间、骨折类型以及术前视觉模拟评分（VAS）、美国足踝外科协会（AOFAS）评分等方面比较，差异均无统计学意义（P>0.05）。记录并比较两组患者的手术时间及骨折愈合时间。拍摄X线片评估踝关节复位及固定效果。采用Olerud-Molander踝关节骨折疗效评分（简称OM评分）、AOFAS评分及VAS评分评估疗效。
两组患者手术时间比较，差异无统计学意义（t=-0.683，P=0.497）。对照组术后外侧切口出现1例延迟愈合、1例愈合不佳，经换药后愈合；其余患者切口均一期愈合。两组患者均随访12~24个月，平均13.8个月。对照组1例旋前外旋型骨折患者术后8周拆除下胫腓联合金属螺钉后负重行走，外踝解剖钢板断裂，再次行外踝固定，5个月后恢复；1例患者术后踝关节轻度疼痛，术后8周拆除下胫腓联合金属螺钉后疼痛消失。所有患者均未发生神经、血管损伤等并发症。两组患者骨折愈合时间比较，差异无统计学意义（t=-1.128；P=0.264）。两组患者术后12个月时AOFAS及VAS评分均较术前显著改善（P<0.05）。两组患者OM评分比较，差异无统计学意义，两组患者手术前后AOFAS及VAS评分差值比较，差异无统计学意义（P>⁃0.05）。
采用可吸收螺钉修复下胫腓联合损伤能有效恢复踝关节结构，预防踝关节不稳，恢复良好的踝关节功能。可吸收螺钉与金属螺钉疗效差异无统计学意义，且无需二次手术取出螺钉。
