Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
Department of Laboratory Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Medicina (Kaunas). 2023 Nov 21;59(12):2048. doi: 10.3390/medicina59122048.
While numerous studies have been conducted on syndesmotic screw management following distal tibiofibular diastasis repair, a clear consensus remains unclear. This research aims to evaluate whether the postoperative removal of syndesmotic screws leads to improved patient outcomes, specifically in quality of life, mobility, and daily living activities, and whether it offers a cost-effective solution. Patients with a history of unimalleolar or bimalleolar ankle fractures, classified according to the Danis-Weber and Lauge-Hansen systems, were included. Comprehensive evaluations were made via standardized questionnaires like the SF-36 Health Survey, HADS, and WHOQOL-BREF, distributed approximately 2 months post surgery. A total of 93 patients underwent syndesmotic screw removal while 51 retained the screws (conservative approach). Patients who underwent screw removal reported superior satisfaction in mobility, with a score of 7.8, compared to 6.7 in the conservative approach ( = 0.018). Similarly, their ability to perform daily activities scored 8.1, higher than the 6.5 from the conservative cohort ( < 0.001). Pain levels were also more favorable in the screw removal group, with a score of 5.3 against 6.8 in the conservative group ( = 0.003). On the SF-36 physical domain, the screw removal group achieved a mean score of 55.9 versus 53.3 for the conservative group ( = 0.027). Notably, the HADS anxiety subscale highlighted reduced anxiety levels in the screw removal cohort with a mean score of 5.8 against 7.3 in the conservative group ( = 0.006). However, overall quality of life and recommendations to others showed no significant difference between the groups. Syndesmotic screw removal postoperatively leads to marked improvements in patients' mobility, daily activity abilities, and reduced postoperative pain and anxiety levels. However, overall quality of life was similar between the two approaches. The findings offer valuable insights for orthopedic decision making and patient-centered care concerning the management of syndesmotic screws after distal tibiofibular diastasis repair.
虽然已经有许多关于下胫腓联合螺钉固定术后处理的研究，但仍未达成明确共识。本研究旨在评估下胫腓联合螺钉术后是否去除能改善患者的预后，特别是在生活质量、活动能力和日常生活活动方面，以及是否具有成本效益。 纳入单侧或双侧踝关节骨折患者，根据 Danis-Weber 和 Lauge-Hansen 系统进行分类。术后约 2 个月，通过 SF-36 健康调查、HADS 和 WHOQOL-BREF 等标准化问卷进行全面评估。共有 93 例患者接受了下胫腓联合螺钉去除术，而 51 例患者保留了螺钉（保守治疗）。 去除螺钉的患者在活动能力方面的满意度评分更高，为 7.8 分，而保守治疗组的评分为 6.7 分（ = 0.018）。同样，他们进行日常活动的能力评分为 8.1 分，高于保守组的 6.5 分（ < 0.001）。在螺钉去除组中，疼痛水平也更有利，评分为 5.3 分，而保守组的评分为 6.8 分（ = 0.003）。在 SF-36 生理领域，螺钉去除组的平均评分为 55.9 分，而保守组的平均评分为 53.3 分（ = 0.027）。值得注意的是，HADS 焦虑量表显示，螺钉去除组的焦虑水平降低，平均评分为 5.8 分，而保守组的评分为 7.3 分（ = 0.006）。然而，两组患者的总体生活质量和向他人推荐的意愿均无显著差异。 术后下胫腓联合螺钉去除可显著改善患者的活动能力、日常活动能力，并减轻术后疼痛和焦虑水平。然而，两种方法的总体生活质量相似。这些发现为下胫腓联合螺钉固定术后处理提供了有价值的见解，有助于骨科医生做出决策和以患者为中心进行护理。
