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[1]安彪,范小波.TightRope帶袢鋼板內(nèi)固定與皮質(zhì)骨螺釘內(nèi)固定治療踝關節(jié)骨折合并的下脛腓聯(lián)合損傷的對比研究[J].中醫(yī)正骨,2025,37(03):39-45.
 AN Biao,FAN Xiaobo.A comparative study of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis injuries associated with ankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(03):39-45.
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TightRope帶袢鋼板內(nèi)固定與皮質(zhì)骨螺釘內(nèi)固定治療踝關節(jié)骨折合并的下脛腓聯(lián)合損傷的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期數(shù):
2025年03期
頁碼:
39-45
欄目:
臨床研究
出版日期:
2025-03-20

文章信息/Info

Title:
A comparative study of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis injuries associated with ankle fractures
作者:
安彪范小波
邯鄲市第一醫(yī)院,河北 邯鄲 056004
Author(s):
AN BiaoFAN Xiaobo
The First Hospital of Handan,Handan 056004,Hebei,China
關鍵詞:
踝骨折 下脛腓聯(lián)合損傷 骨折固定術內(nèi) 骨螺絲 TightRope帶袢鋼板
Keywords:
anklefractures distal tibiofibular syndesmosis injuries fracture fixationinternal bone screws TightRope loop steel plate
摘要:
目的:比較TightRope帶袢鋼板內(nèi)固定和皮質(zhì)骨螺釘內(nèi)固定治療踝關節(jié)骨折合并的下脛腓聯(lián)合損傷的臨床療效和安全性。方法:回顧性分析2021年3月至2023年4月,在邯鄲市第一醫(yī)院接受內(nèi)固定手術治療的110例踝關節(jié)骨折合并下脛腓聯(lián)合損傷患者的病例資料,其中下脛腓聯(lián)合損傷采用TightRope帶袢鋼板內(nèi)固定56例(帶袢鋼板組)、采用皮質(zhì)骨螺釘內(nèi)固定54例(螺釘組)。比較2組患者術中下脛腓聯(lián)合固定用時、術中失血量、術后住院天數(shù)、術后完全負重時間、下脛腓間隙、下脛腓重疊距離、踝關節(jié)功能,以及下脛腓再分離和并發(fā)癥發(fā)生情況。結果:帶袢鋼板組術后完全負重時間早于螺釘組[(8.36±2.41)周,(10.57±2.69)周,t=4.542,P=0.000],但2組患者術中下脛腓聯(lián)合固定用時、術中失血量、術后住院天數(shù)的組間差異均無統(tǒng)計學意義。2組患者下脛腓間隙均隨時間變小[(8.05±2.39)mm,(3.78±0.84)mm,(3.66±0.72)mm,(3.63±0.70)mm,F=143.478,P=0.000;(7.78±2.14)mm,(3.63±0.79)mm,(3.58±0.64)mm,(3.57±0.67)mm,F=156.160,P=0.000],下脛腓重疊距離均隨時間呈先增加后減小的趨勢[(1.72±0.52)mm,(9.06±1.94)mm,(8.93±1.81)mm,(8.91±1.78)mm,F=280.745,P=0.000;(1.87±0.56)mm,(8.85±1.81)mm,(8.79±1.77)mm,(8.75±1.72)mm,F=267.660,P=0.000],且2組的變化趨勢均一致。術后3個月和術后6個月,帶袢鋼板組踝關節(jié)背伸和跖屈活動度均大于螺釘組[5.26°±1.14°,4.82°±0.95°,t=2.195,P=0.030; 9.11°±1.18°,8.47°±1.23°,t=2.785,P=0.006; 17.58°±2.92°,16.09°±3.13°,t=2.583,P=0.011; 27.83°±2.61°,26.58°±2.37°,t=2.627,P=0.010],美國足與踝關節(jié)協(xié)會踝與后足評分均高于螺釘組[(68.29±10.45)分,(64.11±9.03)分,t=2.241,P=0.027;(83.46±7.20)分,(79.78±8.64)分,t=2.430,P=0.017]。術后帶袢鋼板組發(fā)生下脛腓再分離1例,螺釘組發(fā)生下脛腓再分離2例,2組患者下脛腓再分離發(fā)生率的差異無統(tǒng)計學意義(χ2=0.001,P=0.975); 帶袢鋼板組并發(fā)切口感染2例、內(nèi)固定松動1例,螺釘組并發(fā)切口感染2例、內(nèi)固定松動3例,2組患者并發(fā)癥發(fā)生率的差異無統(tǒng)計學意義(χ2=0.227,P=0.634)。結論:對于踝關節(jié)骨折合并下脛腓聯(lián)合損傷患者,采用TightRope帶袢鋼板內(nèi)固定和皮質(zhì)骨螺釘內(nèi)固定下脛腓聯(lián)合,均能獲得良好的復位固定效果,二者在手術損傷和安全性方面相當,但前者術后完全負重時間更早,踝關節(jié)功能恢復更好。
Abstract:
Objective:To compare the clinical efficacy and safety of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis(DTFS)injuries associated with ankle fractures.Methods:The medical records of 110 patients who underwent internal fixation surgery for DTFS injuries associated with ankle fractures at The First Hospital of Handan from March 2021 to April 2023 were retrospectively analyzed.Fifty-six patients were treated with TightRope loop steel plate internal fixation(loop steel plate group),while the others with cortical bone screw internal fixation(screw group).The intraoperative time consuming for fixation of DTFS,intraoperative blood loss,postoperative hospital stays,postoperative full weight-bearing walking start time,distal tibiofibular clear space,distal tibiofibular overlap distance,ankle function,distal tibiofibular re-separation incidence and complication incidence were compared between the 2 groups.Results:The postoperative full weight-bearing walking start time was shorter in loop steel plate group compared to screw group(8.36±2.41 vs 10.57±2.69 weeks,t=4.542,P=0.000),while,the intraoperative time consuming for fixation of DTFS,intraoperative blood loss and postoperative hospital stays were not statistical significant between the 2 groups.The distal tibiofibular clear space decreased over time in the 2 groups(8.05±2.39,3.78±0.84,3.66±0.72,3.63±0.70 mm,F=143.478,P=0.000; 7.78±2.14,3.63±0.79,3.58±0.64,3.57±0.67 mm,F=156.160,P=0.000),while the distal tibiofibular overlap distance presented a trend of increased initially and decreased subsequently over time in the 2 groups(1.72±0.52,9.06±1.94,8.93±1.81,8.91±1.78 mm,F=280.745,P=0.000; 1.87±0.56,8.85±1.81,8.79±1.77,8.75±1.72 mm,F=267.660,P=0.000),and the 2 groups were consistent with each other in the variation tendency.At postsurgical month 3 and 6,the range of motions(ROMs)including dorsal extension and plantar flexion were greater,and the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was higher in loop steel plate group compared to screw group(5.26±1.14 vs 4.82±0.95 degrees,t=2.195,P=0.030; 9.11±1.18 vs 8.47±1.23 degrees,t=2.785,P=0.006; 17.58±2.92 vs 16.09±3.13 degrees,t=2.583,P=0.011; 27.83±2.61 vs 26.58±2.37 degrees,t=2.627,P=0.010; 68.29±10.45 vs 64.11±9.03 points,t=2.241,P=0.027; 83.46±7.20 vs 79.78±8.64 points,t=2.430,P=0.017).After the surgery,the distal tibiofibular re-separation was found in 1 patient in loop steel plate group and 2 patients in screw group.There was no statistical difference in the distal tibiofibular re-separation incidence between the 2 groups(χ2=0.001,P=0.975).Besides,the incision infection was found in loop steel plate group and screw group in 2 patients,respectively,and the internal fixation loosening was found in 1 patient in loop steel plate group and 3 patients in screw group.There was no statistical difference in the complication incidence between the 2 groups(χ2=0.227,P=0.634).Conclusion:Both TightRope loop steel plate internal fixation and cortical bone screw internal fixation can achieve good reduction and fixation effects in treatment of DTFS injuries associated with ankle fractures,and the both are comparable in surgical injury and safety,while the former displays the advantages of earlier full weight-bearing and better ankle function recovery after the surgery compared to the latter.

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相似文獻/References:

[1]包學迅,王賀輝,郁耀平,等.TightRope鋼板內(nèi)固定治療三踝骨折合并下脛腓聯(lián)合損傷[J].中醫(yī)正骨,2017,29(08):65.

備注/Memo

備注/Memo:
基金項目:河北省醫(yī)學科學研究課題計劃項目(20231919)
通訊作者:范小波 E-mail:[email protected]
更新日期/Last Update: 1900-01-01