[1]段添栋,刘伟.TightRope带袢钢板内固定治疗踝关节骨折合并的下胫腓联合损伤[J].中医正骨,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带袢钢板内固定治疗踝关节骨折合并的下胫腓联合损伤()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年12期
页码:
36-41,44
栏目:
临床研究
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:
段添栋; 刘伟
(上海交通大学医学院附属瑞金医院舟山分院,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
关键词:
踝部骨折;  下胫腓联合;  骨折固定术; 内;  TightRope带袢钢板;  骨螺丝
Keywords:
ankle fractures;  distal tibiofibular syndesmosis;  fracture fixation; internal;  Tightrope plate;  bone screws
摘要:
目的:观察TightRope带袢钢板内固定治疗踝关节骨折合并的下胫腓联合损伤的临床疗效和安全性。方法:将符合要求的60例踝关节骨折合并下胫腓联合损伤患者随机分为2组,每组30例。2组患者均采用外踝解剖锁定钢板内固定治疗外踝骨折,采用空心螺钉加压固定治疗后踝和内踝骨折; 对于合并的下胫腓联合损伤,分别采用TightRope带袢钢板内固定(带袢钢板内固定组)和螺钉内固定(螺钉内固定组)治疗。分别于术前及术后1个月、3个月、6个月,拍摄踝关节正侧位X线片,于踝关节正位X线片上测量下胫腓间隙和下胫腓重叠; 采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价踝关节功能; 随访观察并发症发生情况。结果:①下胫腓间隙。时间因素和分组因素不存在交互效应(F=0.384,P=0.538); 2组患者的下胫腓间隙比较,差异无统计学意义,即不存在分组效应(F=0.530,P=0.590); 手术前后不同时间点下胫腓间隙的差异有统计学意义,即存在时间效应(F=18.707,P=0.000); 2组患者手术前后下胫腓间隙均呈下降趋势,但2组的下降趋势不完全一致[(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]; 术前,2组患者下胫腓间隙组间比较,差异无统计学意义(t=1.114,P=0.270); 术后1个月、3个月、6个月,带袢钢板内固定组患者下胫腓间隙均小于螺钉内固定组(t=5.356,P=0.000; t=11.894,P=0.000; t=4.725,P=0.000)。②下胫腓重叠。时间因素和分组因素存在交互效应(F=8.142,P=0.006); 2组患者的下胫腓重叠比较,差异无统计学意义,即不存在分组效应(F=2.519,P=0.085); 手术前后不同时间点下胫腓重叠的差异有统计学意义,即存在时间效应(F=30.532,P=0.000); 2组患者手术前后下胫腓重叠均呈先下降后上升趋势,但2组的变化趋势不完全一致[(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]; 术前,2组患者下胫腓重叠组间比较,差异无统计学意义(t=0.426,P=0.672); 术后1个月、3个月、6个月,带袢钢板内固定组患者下胫腓重叠均大于螺钉内固定组(t=11.127,P=0.000; t=5.352,P=0.000; t=5.757,P=0.000)。③AOFAS踝与后足评分。时间因素和分组因素存在交互效应(F=134.589,P=0.000); 2组患者的AOFAS踝与后足评分比较,差异无统计学意义,即不存在分组效应(F=1.419,P=0.246); 手术前后不同时间点AOFAS踝与后足评分的差异有统计学意义,即存在时间效应(F=54.613,P=0.000); 2组患者手术前后AOFAS踝与后足评分均呈上升趋势,但2组的上升趋势不完全一致[(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]; 术前,2组患者AOFAS踝与后足评分组间比较,差异无统计学意义(t=0.146,P=0.884); 术后1个月、3个月、6个月,带袢钢板内固定组患者AOFAS踝与后足评分均大于螺钉内固定组(t=3.115,P=0.003; t=11.817,P=0.000; t=8.740,P=0.000)。④并发症。带袢钢板内固定组和螺钉内固定组各有1例患者术后出现软组织激惹症状,采用按摩、热敷等方法治疗后症状缓解。螺钉内固定组2例患者发生下胫腓联合固定螺钉松动,取出螺钉再次固定后固定牢靠。2组患者并发症发生率比较,差异无统计学意义(χ2=1.071,P=0.301)。结论:采用TightRope带袢钢板内固定治疗踝关节骨折合并的下胫腓联合损伤,与螺钉内固定治疗比较,更有利于恢复下胫腓联合的解剖结构和踝关节功能,且二者安全性相当。
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 本文编辑:吕宁)

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