踝关节骨折合并下胫腓联合韧带损伤临床治疗分析
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  • 英文篇名:Clinical analysis of ankle joint fracture combined with syndesmosis ligament injury
  • 作者:陆黎明 ; 刘进炼 ; 张叶松 ; 凡桂勇 ; 孙斌
  • 英文作者:LU Li-ming;LIU Jin-lian;ZHANG Ye-song;FAN Gui-yong;SUN Bin;Department of Orthopedics,Suzhou Kowloon Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University;
  • 关键词:踝关节骨折 ; 下胫腓联合韧带损伤 ; 手术治疗 ; 保守治疗
  • 英文关键词:ankle fracture;;syndesmosis ligament injury;;surgical treatment;;conservative treatment
  • 中文刊名:JJXZ
  • 英文刊名:Journal of Regional Anatomy and Operative Surgery
  • 机构:上海交通大学医学院附属苏州九龙医院骨科;
  • 出版日期:2018-08-25
  • 出版单位:局解手术学杂志
  • 年:2018
  • 期:v.27;No.153
  • 语种:中文;
  • 页:JJXZ201808009
  • 页数:4
  • CN:08
  • ISSN:50-1162/R
  • 分类号:40-43
摘要
目的比较几种治疗踝关节骨折合并下胫腓联合韧带损伤方法的临床效果。方法选取2014年1月至2017年12月我院收治的103例踝关节骨折合并下胫腓联合韧带损伤患者,按照治疗方法分为保守治疗组(对照组),固定内外踝、下胫腓克氏针外固定手术治疗组(观察组1)以及固定内外踝、下胫腓螺钉固定、下腓联合韧带修复治疗组(观察组2),对比分析3组患者临床疗效。结果固定内外踝,下胫腓螺钉固定、下腓联合韧带修复治疗组骨愈合时间、骨不连发生率和二次治疗发生率显著低于保守治疗组及固定内外踝,下胫腓克氏针外固定手术治疗组,差异具有统计学意义(P<0.05),而骨愈合优良率显著高于保守治疗组及固定内外踝,下胫腓克氏针外定手术治疗组,差异具有统计学意义(P<0.05)。结论采用内外踝固定,下胫腓螺钉固定、下腓联合韧带修复治疗踝关节骨折合并下胫腓联合韧带损伤效果较好,而且骨不连发生率和二次治疗发生率低。
        Objective To compare the effects of several commonly used methods for the treatment of ankle joint fracture combined with syndesmosis ligament injury. Methods A total of 103 cases of ankle joint fracture combined with syndesmosis ligament injury patients in our hospital from Janurary 2014 to December 2017 were randomly divided into three groups according to treatment methods,including conservative treatment group,fixed internal and external malleolus,lower tibiofibersyn needle surgery group and fixed internal and external malleolus,tibiofibular screw fixation,fibular ligament repair treatment group,comparing the clinical effects of the three groups. Results The healing time and the incidence of nonunion of bone and secondary treatment of fixed internal and external malleolus,tibiofibular screw fixation,fibular ligament repair treatment group was significance decreased,comparing with conservative treatment group and fixed internal and external malleolus,lower tibiofibersyn needle surgery group,the differences were significant( P < 0. 05). And its excellent and good rate of bone healing significantly higher than conservative treatment group and fixed internal and external malleolus,lower tibiofibersyn needle surgery group,the differences were significant( P < 0. 05). Conclusion The use of fixed internal and external malleolus,tibiofibular screw fixation,fibular ligament repair treatment are effective,with lower incidence of nonunion of bone and secondary treatment.
引文
[1]李峰,刘其明,张珂,等.三踝骨折患者后踝固定对踝关节稳定性及功能恢复的影响[J].局解手术学杂志,2013,22(1):72-73.doi:10.11659/jjssx.1672-5042.2013010031.
    [2]罗振东,翦晓明,赵若愚.踝关节骨折的手术治疗[J].局解手术学杂志,2004,13(1):8-9.doi:10.3969/j.issn.1672-5042.2004.01.004.
    [3]朱靖,江渟.踝关节骨折中下胫腓联合韧带损伤的研究进展[J].中医药临床杂志,2015,27(11):1630-1633.doi:10.16448/j.cjtcm.2015.0605.
    [4]陈滨晖,吕松岑.下胫腓韧带联合损伤的诊治新进展[J].中国综合临床,2016,32(4):382-384.doi:10.3760/cma.j.issn.1008-6315.2016.04.029.
    [5]Sproule JA,Khalid M,O’Sullivan M,et al.Out some after surgery for Mai sonneuve fracture of the fibula[J].Injury,2004,35(8):791-798.doi:10.1016/S0020-1383(03)00155-4.
    [6]Thornes B,Walsh A,Hislop M,et al.Suture-endobutton fixation of ankle tibiofibular diastasis:a cadaver study[J].Foot Ankle Int,2003,24(2):142-146.doi:10.1177/107110070302400208.
    [7]Soin SP,Knight TA,Dinah AF,et al.Suture button versus screw fixationin a syndesmosis rupture model:a biomechanical comparison[J].Foot Ankle Int,2009,30(4):346-352.doi:10.3113/FAI.2009.0346.
    [8]Rammelt S,Obruba P.An update on the evaluation and treatment of syndesmotic injuries[J].Eur J Trauma Emerg Surg,2015,41(6):601-614.doi:10.1007/s00068-014-0466-8.
    [9]van den Bekerom MP,Kloen P,Luitse JS,et al.Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients[J].J Foot Ankle Surg,2013,52(4):456-459.doi:10.1053/j.jfas.2013.03.025.
    [10]Fort NM,Aiyer AA,Kaplan JR,et al.Management of acute injuries of the tibiofibular syndesmosis[J].Eur J Orthop Surg Traumatol,2017,27(4):449-459.doi:10.1007/s00590-017-1956-2.
    [11]Liu Q,Zhao G,Yu B,et al.Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle:a finite element study[J].Knee Surg Sports Traumatol Arthrosc,2016,24(4):1228-1235.doi:10.1007/s00167-014-3320-y.
    [12]翁科捷,钟志刚,张育锋,等.手术治疗踝关节骨折合并下胫腓联合韧带损伤的临床疗效分析[J].临床医学工程,2016,23(5):641-642.doi:10.3969/j.issn.1674-4659.2016.05.0641.
    [13]顾旻,姬健.手术治疗踝关节骨折合并下胫腓联合韧带损伤的临床研究[J].中国实用医药,2016,11(23):115-116.doi:10.14163/j.cnki.11-5547/r.2016.23.081.
    [14]王立.踝关节骨折合并下胫腓联合韧带损伤应用手术治疗的临床分析[J].医疗装备,2016,29(6):126-127.doi:10.3969/j.issn.1002-2376.2016.06.099.
    [15]Snedden MH,Shea JP.Diastasis with low distal fibula fractures:an anatomic rationale[J].Clin Orthop Relat Res,2001(382):197-205.doi:10.1097/00003086-200101000-00027.
    [16]Gardner MJ,Demetrakopoulos D,Briggs SM,et al.The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures:an MRI study[J].Orthop Trauma,2006,20(4):267-272.doi:10.1097/00005131-200604000-00006.
    [17]吴少科,郑鸿,陈航,等.修复与不修复下胫腓前韧带在下胫腓联合损伤治疗中的疗效比较[J].中国骨与关节损伤杂志,2013,28(2):122-124.doi:10.7531/j.issn.1672-9935.2013.02.009.
    [18]Naqvi GA,Shafqat A,Awan N.Tightrope fixation of ankle syndesmosis injuries:clinical outcome,complications and technique modification[J].Injury,2012,43(6):838-842.doi:10.1016/j.injury.2011.10.002.
    [19]Degroot H,Al-Omari AA,El Ghazaly SA.Outcomes of suture button repair of the distal tibiofibular syndesmosis[J].Foot Ankle Int,2011,32(3):250-256.doi:10.3113/FAI.2011.0250.
    [20]De Vil J,Bonte F,Claes H,et al.Bolt fixation for syndesmotic injuries[J].Injury,2009,40(11):1176-1179.doi:10.1016/j.injury.2009.02.013.
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