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[1]段添?xiàng)?劉偉.TightRope帶袢鋼板內(nèi)固定治療踝關(guān)節(jié)骨折合并的下脛腓聯(lián)合損傷[J].中醫(yī)正骨,2022,34(12):36-41,44.
　DUAN Tiandong,LIU Wei.A clinical study of internal fixation with TightRope plate for treatment of ankle fracture combined with lower tibiofibular syndesmosis injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(12):36-41,44.
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TightRope帶袢鋼板內(nèi)固定治療踝關(guān)節(jié)骨折合并的下脛腓聯(lián)合損傷()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年12期
頁碼:
36-41,44
欄目:
臨床研究
出版日期:
2022-12-02

文章信息/Info

Title:
A clinical study of internal fixation with TightRope plate for treatment of ankle fracture combined with lower tibiofibular syndesmosis injury
作者:
劉偉
(上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院舟山分院,浙江 舟山 316000)
Author(s):
DUAN Tiandong; LIU Wei
Zhoushan Branch,Shanghai Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,Zhoushan 316000,Zhejiang,China
關(guān)鍵詞:
踝部骨折;  下脛腓聯(lián)合;  骨折固定術(shù); 內(nèi);  TightRope帶袢鋼板;  骨螺絲
Keywords:
ankle fractures;  distal tibiofibular syndesmosis;  fracture fixation; internal;  Tightrope plate;  bone screws
摘要:
目的:觀察TightRope帶袢鋼板內(nèi)固定治療踝關(guān)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:將符合要求的60例踝關(guān)節(jié)骨折合并下脛腓聯(lián)合損傷患者隨機(jī)分為2組,每組30例。2組患者均采用外踝解剖鎖定鋼板內(nèi)固定治療外踝骨折,采用空心螺釘加壓固定治療后踝和內(nèi)踝骨折; 對(duì)于合并的下脛腓聯(lián)合損傷,分別采用TightRope帶袢鋼板內(nèi)固定(帶袢鋼板內(nèi)固定組)和螺釘內(nèi)固定(螺釘內(nèi)固定組)治療。分別于術(shù)前及術(shù)后1個(gè)月、3個(gè)月、6個(gè)月,拍攝踝關(guān)節(jié)正側(cè)位X線片,于踝關(guān)節(jié)正位X線片上測量下脛腓間隙和下脛腓重疊; 采用美國足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)踝關(guān)節(jié)功能; 隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:①下脛腓間隙。時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.384,P=0.538); 2組患者的下脛腓間隙比較,差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.530,P=0.590); 手術(shù)前后不同時(shí)間點(diǎn)下脛腓間隙的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=18.707,P=0.000); 2組患者手術(shù)前后下脛腓間隙均呈下降趨勢,但2組的下降趨勢不完全一致[(8.50±1.41)mm,(3.57±0.50)mm,(3.07±0.36)mm,(2.83±0.38)mm,F=345.503,P=0.000;(8.90±1.37)mm,(4.20±0.41)mm,(4.10±0.30)mm,(3.47±0.63)mm,F=298.411,P=0.000]; 術(shù)前,2組患者下脛腓間隙組間比較,差異無統(tǒng)計(jì)學(xué)意義(t=1.114,P=0.270); 術(shù)后1個(gè)月、3個(gè)月、6個(gè)月,帶袢鋼板內(nèi)固定組患者下脛腓間隙均小于螺釘內(nèi)固定組(t=5.356,P=0.000; t=11.894,P=0.000; t=4.725,P=0.000)。②下脛腓重疊。時(shí)間因素和分組因素存在交互效應(yīng)(F=8.142,P=0.006); 2組患者的下脛腓重疊比較,差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=2.519,P=0.085); 手術(shù)前后不同時(shí)間點(diǎn)下脛腓重疊的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=30.532,P=0.000); 2組患者手術(shù)前后下脛腓重疊均呈先下降后上升趨勢,但2組的變化趨勢不完全一致[(9.93±0.25)mm,(8.53±0.51)mm,(8.77±0.73)mm,(9.07±0.36)mm,F=578.357,P=0.000;(9.87±0.82)mm,(8.00±0.01)mm,(8.03±0.18)mm,(8.10±0.30)mm,F=25.610,P=0.000]; 術(shù)前,2組患者下脛腓重疊組間比較,差異無統(tǒng)計(jì)學(xué)意義(t=0.426,P=0.672); 術(shù)后1個(gè)月、3個(gè)月、6個(gè)月,帶袢鋼板內(nèi)固定組患者下脛腓重疊均大于螺釘內(nèi)固定組(t=11.127,P=0.000; t=5.352,P=0.000; t=5.757,P=0.000)。③AOFAS踝與后足評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=134.589,P=0.000); 2組患者的AOFAS踝與后足評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.419,P=0.246); 手術(shù)前后不同時(shí)間點(diǎn)AOFAS踝與后足評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=54.613,P=0.000); 2組患者手術(shù)前后AOFAS踝與后足評(píng)分均呈上升趨勢,但2組的上升趨勢不完全一致[(64.67±2.59)mm,(70.57±2.76)mm,(83.33±3.15)mm,(91.53±2.63)mm,F=569.177,P=0.000;(64.77±2.70)mm,(68.50±2.36)mm,(74.50±2.61)mm,(85.63±2.59)mm,F=377.956,P=0.000]; 術(shù)前,2組患者AOFAS踝與后足評(píng)分組間比較,差異無統(tǒng)計(jì)學(xué)意義(t=0.146,P=0.884); 術(shù)后1個(gè)月、3個(gè)月、6個(gè)月,帶袢鋼板內(nèi)固定組患者AOFAS踝與后足評(píng)分均大于螺釘內(nèi)固定組(t=3.115,P=0.003; t=11.817,P=0.000; t=8.740,P=0.000)。④并發(fā)癥。帶袢鋼板內(nèi)固定組和螺釘內(nèi)固定組各有1例患者術(shù)后出現(xiàn)軟組織激惹癥狀,采用按摩、熱敷等方法治療后癥狀緩解。螺釘內(nèi)固定組2例患者發(fā)生下脛腓聯(lián)合固定螺釘松動(dòng),取出螺釘再次固定后固定牢靠。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=1.071,P=0.301)。結(jié)論:采用TightRope帶袢鋼板內(nèi)固定治療踝關(guān)節(jié)骨折合并的下脛腓聯(lián)合損傷,與螺釘內(nèi)固定治療比較,更有利于恢復(fù)下脛腓聯(lián)合的解剖結(jié)構(gòu)和踝關(guān)節(jié)功能,且二者安全性相當(dāng)。
Abstract:
Ojective:To observe and evaluate the clinical efficacy and safety of internal fixation with TightRope plate in the treatment of ankle fracture combined with lower tibiofibular syndesmosis injury.Methods:Sixty patients with ankle fracture combined with lower tibiofibular syndesmosis injury were randomly divided into two groups with 30 patients in each group.Lateral malleolus fractures were treated with internal fixation with anatomic locking plate,and posterior malleolus fractures and medial malleolus fractures were treated with internal fixation with hollow compression screw.The lower tibiofibular syndesmosis injuries were treated with internal fixation with TightRope plate(TightRope plate group)and bone screw internal fixation(bone screw group).Anteroposterior and lateral ankle radiographs were taken before surgery and at 1,3,and 6 months after surgery.The lower tibiofibular space and overlap were measured on anteroposterior ankle radiographs.The ankle function was evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score.The occurrence of complications was observed during follow-up visits.Results:①Lower tibiofibular space.No interaction between the time factor and the grouping factor was observed(F=0.384,P=0.538).There was no significant difference in lower tibiofibular space between the two groups,which indicated no grouping effect(F=0.530,P=0.590).The lower tibiofibular space showed significant differences at different time points before and after surgery,which was indicative of a time effect(F=18.707,P=0.000).The lower tibiofibular space in both groups showed a downward trend before and after surgery,but the downward trend was not completely consistent between the two groups((8.50±1.41)mm,(3.57±0.50)mm,(3.07±0.36)mm,(2.83±0.38)mm,F=345.503,P=0.000;(8.90±1.37)mm,(4.20±0.41)mm,(4.10±0.30)mm,(3.47±0.63)mm,F=298.411,P=0.000).Before surgery,there was no significant difference in the lower tibiofibular space between the two groups(t=1.114,P=0.270).At 1,3,and 6 months after surgery,the lower tibiofibular space of patients in the TightRope plate group was smaller than that in the bone screw group(t=5.356,P=0.000; t=11.894,P=0.000; t=4.725,P=0.000).②Lower tibiofibular overlap.There was an interaction between the time factor and the grouping factor(F=8.142,P=0.006).There was no significant difference in the lower tibiofibular overlap between the two groups,indicating no grouping effect(F=2.519,P=0.085).There were significant differences in the lower tibiofibular overlap at different time points before and after surgery,which was indicative of a time effect(F=30.532,P=0.000).Before and after surgery,the lower tibiofibular overlap of the two groups decreased first and then increased,but the changing trend was not completely consistent between the two groups((9.93±0.25)mm,(8.53±0.51)mm,(8.77±0.73)mm,(9.07±0.36)mm,F=578.357,P=0.000;(9.87±0.82)mm,(8.00±0.01)mm,(8.03±0.18)mm,(8.10±0.30)mm,F=25.610,P=0.000).Before surgery,there was no statistical difference in the lower tibiofibular overlap between the two groups(t=0.426,P=0.672).At 1,3 and 6 months after surgery,the lower tibiofibular overlap of patients in the TightRope plate group was larger than that in the bone screw group(t=11.127,P=0.000; t=5.352,P=0.000; t=5.757,P=0.000).③AOFAS ankle-hindfoot score.There was an interaction between the time factor and the grouping factor(F=134.589,P=0.000).No significant difference in AOFAS ankle-hindfoot score between the two groups was observed(F=1.419,P=0.246).There were significant differences in AOFAS ankle-hindfoot score at different time points before and after surgery,indicating a time effect(F=54.613,P=0.000).AOFAS ankle-hindfoot scores in both groups showed an upward trend before and after surgery,but the upward trend was not completely consistent between the two groups((64.67±2.59)mm,(70.57±2.76)mm,(83.33±3.15)mm,(91.53±2.63)mm,F=569.177,P=0.000;(64.77±2.70)mm,(68.50±2.36)mm,(74.50±2.61)mm,(85.63±2.59)mm,F=377.956,P=0.000).Before surgery, there was no significant difference in AOFAS ankle-hindfoot score between the two groups(t=0.146,P=0.884).At 1,3,and 6 months after surgery,the AOFAS ankle-hindfoot score in the TightRope plate group was higher than that in the bone screw group(t=3.115,P=0.003; t=11.817,P=0.000; t=8.740,P=0.000).④Complications.One patient in the TightRope plate group and one in the bone screw group had postoperative symptom of soft tissue irritation that was relieved by massage and hot compress.Two patients in the bone screw group had the screw looseness,and the screw was removed and fixed stably.There was no significant difference in the incidence of complications between the two groups(χ2=1.071,P=0.301).Conclusion:Compared with bone screw internal fixation,the internal fixation with TightRope plate for the treatment of ankle fracture combined with lower tibiofibular syndesmosis injury is beneficial to the recovery of anatomic structure of lower tibiofibular syndesmosis and ankle function.The safety of the two treatments is comparable.

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(收稿日期:2022-07-19 本文編輯:呂寧)

相似文獻(xiàn)/References:

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[2]張琪,成永忠,黃曉宇,等.閉合復(fù)位外固定架固定治療合并下脛腓聯(lián)合分離的旋前-外展型三踝骨折的穩(wěn)定性研究[J].中醫(yī)正骨,2020,32(02):14.
　ZHANG Qi,CHENG Yongzhong,HUANG Xiaoyu,et al.A study of stability of closed reduction and frame external fixation in the treatment of pronation-abduction-type trimalleolar fractures combined with distal tibiofibular syndesmosis separation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(12):14.
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通訊作者:劉偉 E-mail:[email protected]
更新日期/Last Update: 1900-01-01