应用5mm部分螺纹空心螺钉治疗下胫腓联合分离合并踝关节骨折的疗效研究
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摘要
目的探讨5mm部分螺纹空心螺钉治疗下胫腓联合分离合并踝关节骨折的疗效结果。方法回顾性分析应用5mm部分螺纹空心螺钉治疗下胫腓联合分离合并踝关节骨折的患者97例临床资料。所有患者术前及术后1月、1年均予以拍摄双侧踝关节正侧位片,比较患肢与对侧健肢踝关节影像学结果,并评估患者术后1个月及1年的美国足踝外科医师协会踝与后足功能评分(AOFAS)。结果术前,患肢的影像学参数内踝间隙、胫腓骨间隙及侧位片腓骨位置高于健肢踝关节,而患肢的胫腓骨重叠低于健肢踝关节,差异均有统计学意义(t分别=10.41、5.53、2.81、6.90,P均<0.05)。术后1月复查时,患肢的内踝间隙、胫腓骨间隙、侧位片腓骨位置均明显低于术前,胫腓骨重叠高于术前,差异均有统计学意义(t分别=6.84、6.88、5.28、2.92,P均<0.05),患肢内踝间隙仍高于健肢踝关节,AOFAS评分低于健肢踝关节(t分别=12.43、60.79,P均<0.05),患肢胫腓骨重叠、胫腓骨间隙及侧位片腓骨位置与健肢踝关节相比,差异均无统计学意义(t分别=0.26、0.72、0.86,P均>0.05)。术后1年复查时,患肢的影像学参数和AOFAS评分与健肢踝关节比较,差异均无统计学意义(t分别=0.57、0.45、1.52、0.87、1.66,P均>0.05)。结论应用5mm部分螺纹空心螺钉治疗下胫腓联合分离合并踝关节骨折是有效的,能有效恢复并保持踝关节胫腓骨之间正常的解剖关系,且术后功能康复良好。
Objective To explore clinical effect of 5 mm partially threaded cannulated screw on tibiofibular syndesmotic separation combined with ankle fractures. Methods The data of 97 patients with tibiofibular syndesmotic separation combined with ankle fractures treated with 5 mm partially threaded cannulated screw was retrospectively analyzed.All patients underwent bilateral lateral ankle radiographs before surgery,1 month and 1 year after surgery.The images of the affected limb and contralateral ankle joint were compared,and AOFAS scores were evaluated 1 month and 1 year after surgery. Results Before surgery,the imaging parameters of the affected limbs including medial malleolus space,tibiofibular space and fibula position on lateral film were higher than the ankle joints of healthy limbs,and the tibia overlap of the affected limbs was lower than that of the healthy limbs(t=10.41,5.53,2.81,6.90,P<0.05).One month after surgery,the medial malleolus space,tibiofibular space and fibula position on lateral film of the affected limbs were significantly lower than those before surgery,and the tibia overlap was higher than that before surgery(t= 6.84,6.88,5.28,2.92,P<0.05).The medial malleolus space of the affected limb was significantly higher than that of the ankle joint of healthy limb, and the AOFAS score was lower(t=12.43,60.79, P<0.05). One month after surgery,there were no significant differences in the the medial malleolus space,tibiofibular space and fibula position on lateral film between the ankle joints of affected limb and healthy limb(t=0.26,0.72,0.86,P>0.05). One year after surgery,the medial malleolus space,tibiofibular space,fibula position on lateral film,and AOFAS scores between the affected limb and healthy limb were not statistically different(t=0.57,0.45,1.52,0.87,1.66,P>0.05). Conclusion The 5 mm partial-threaded cannulated screw in the treatment of tibiofibular syndesmotic separation combined with ankle fractures is effective.It can effectively restore and maintain the normal anatomical relationship between the tibia and fibula of the ankle joint,and well-recovered.
Objective To explore clinical effect of 5 mm partially threaded cannulated screw on tibiofibular syndesmotic separation combined with ankle fractures. Methods The data of 97 patients with tibiofibular syndesmotic separation combined with ankle fractures treated with 5 mm partially threaded cannulated screw was retrospectively analyzed.All patients underwent bilateral lateral ankle radiographs before surgery,1 month and 1 year after surgery.The images of the affected limb and contralateral ankle joint were compared,and AOFAS scores were evaluated 1 month and 1 year after surgery. Results Before surgery,the imaging parameters of the affected limbs including medial malleolus space,tibiofibular space and fibula position on lateral film were higher than the ankle joints of healthy limbs,and the tibia overlap of the affected limbs was lower than that of the healthy limbs(t=10.41,5.53,2.81,6.90,P<0.05).One month after surgery,the medial malleolus space,tibiofibular space and fibula position on lateral film of the affected limbs were significantly lower than those before surgery,and the tibia overlap was higher than that before surgery(t= 6.84,6.88,5.28,2.92,P<0.05).The medial malleolus space of the affected limb was significantly higher than that of the ankle joint of healthy limb, and the AOFAS score was lower(t=12.43,60.79, P<0.05). One month after surgery,there were no significant differences in the the medial malleolus space,tibiofibular space and fibula position on lateral film between the ankle joints of affected limb and healthy limb(t=0.26,0.72,0.86,P>0.05). One year after surgery,the medial malleolus space,tibiofibular space,fibula position on lateral film,and AOFAS scores between the affected limb and healthy limb were not statistically different(t=0.57,0.45,1.52,0.87,1.66,P>0.05). Conclusion The 5 mm partial-threaded cannulated screw in the treatment of tibiofibular syndesmotic separation combined with ankle fractures is effective.It can effectively restore and maintain the normal anatomical relationship between the tibia and fibula of the ankle joint,and well-recovered.
引文
1 Fort NM,Aiyer AA,Kaplan JR,et al. Management of acute injuries of the tibiofibular syndesmosis[J].EJOST,2017,27(4):449-459.
2 许斌,朱求亮,赵立来,等.后外侧入路双钢板固定治疗踝关节骨折伴后脱位的疗效分析[J].全科医学临床与教育,2014,12(5):570-571.
3 Mróz I,Bachul PJ,Tomaszewski KA,et al.Classifica?tion system of the tibiofibular syndesmosis blood supply and its clinical relevance[J].Scientific Reports,2018,8(1):105-107.
4 Ramsey DC. Cost-Effectiveness analysis of syndesmotic screw versus suture button fixation in tibiofibular syndes?motic injuries[J].J Orthop Trauma, 2018,32(6):e198-e203.
5 叶永志,张隆英,陈榆.锁扣带袢钛板与传统螺钉治疗踝关节骨折伴下胫腓联合损伤疗效比较[J].中国骨伤,2017,30(5):441-445.
6 Suero EM,Hawi N,Westphal R,et al.The effect of dis?tal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints[J].Knee Surg Sports Traumatol Arthrosc,2017,25(1):299-305.
7 Fort NM,Aiyer AA,Kaplan JR,et al.Management of acute injuries of the tibiofibular syndesmosis[J].Euro J Orthop Sur Traumatol,2017,27(4):449-459.
8 Zhang P,Liang Y,He J,et al.A systematic review of su?ture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury[J].BMC Musculo?skel Dis,2017,18(1):286.
9 Peterson KS,Chapman WD,Hyer CF.Maintenance of re?duction with suture button fixation devices for ankle syndesmosis repair[J].FAI,2015,36(6):679-684.
2 许斌,朱求亮,赵立来,等.后外侧入路双钢板固定治疗踝关节骨折伴后脱位的疗效分析[J].全科医学临床与教育,2014,12(5):570-571.
3 Mróz I,Bachul PJ,Tomaszewski KA,et al.Classifica?tion system of the tibiofibular syndesmosis blood supply and its clinical relevance[J].Scientific Reports,2018,8(1):105-107.
4 Ramsey DC. Cost-Effectiveness analysis of syndesmotic screw versus suture button fixation in tibiofibular syndes?motic injuries[J].J Orthop Trauma, 2018,32(6):e198-e203.
5 叶永志,张隆英,陈榆.锁扣带袢钛板与传统螺钉治疗踝关节骨折伴下胫腓联合损伤疗效比较[J].中国骨伤,2017,30(5):441-445.
6 Suero EM,Hawi N,Westphal R,et al.The effect of dis?tal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints[J].Knee Surg Sports Traumatol Arthrosc,2017,25(1):299-305.
7 Fort NM,Aiyer AA,Kaplan JR,et al.Management of acute injuries of the tibiofibular syndesmosis[J].Euro J Orthop Sur Traumatol,2017,27(4):449-459.
8 Zhang P,Liang Y,He J,et al.A systematic review of su?ture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury[J].BMC Musculo?skel Dis,2017,18(1):286.
9 Peterson KS,Chapman WD,Hyer CF.Maintenance of re?duction with suture button fixation devices for ankle syndesmosis repair[J].FAI,2015,36(6):679-684.