目的 比较锁扣带袢钛板和单枚皮质骨螺钉治疗踝关节骨折中下胫腓损伤的临床疗效.方法 回顾分析 2020 年 1 月至 2022 年 1 月我院治疗的 61 例踝关节骨折伴下胫腓损伤患者的临床资料,根据下胫腓固定方法的不同分为锁扣带袢钛板组(A 组)与单枚皮质骨螺钉组(B 组).其中 A 组 28 例,B 组 33 例,比较两组患者早、中远期功能结果,下胫腓联合影像学变化,手术时间,住院时间及并发症,分析影响早期踝关节功能的危险因素.结果 术后 1 个月 A 组踝关节活动度评分(17.2±1.2)分高于 B 组(15.8±2.3)分,差异有统计学意义(P=0.005).术后 3 个月 A 组美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)评分为 91(80～98)分,高于 B 组 80(68～87)分,差异有统计学意义(P=0.003);术后 6 个月、12 个月时两组 AOFAS 评分比较差异无统计学意义(P>0.05).术后 1 个月和 3 个月两组下胫腓间隙和下胫腓重叠距离与出院前比较差异无统计学意义(P>0.05).两组患者手术时间、住院时间、并发症比较差异均无统计学意义(P>0.05).螺钉固定是术后 1个月踝关节活动度<15分(P=0.011)和术后 3个月踝关节 AOFAS评分<90 分(P=0.032)的独立危险因素.结论 锁扣带袢钛板治疗踝关节骨折中下胫腓联合损伤与单枚皮质骨螺钉同样安全有效,但早期功能结果优于螺钉固定,中长期结果相当,螺钉固定是影响早期功能结果的独立危险因素.
Comparison of the therapeutic effects of suture button titanium plate and single cortical screw in the treatment of ankle fractures with lower tibiofibular syndesmosis injury
Objective To compare the clinical efficacy of suture button titanium plate and single cortical screw in the treatment of lower tibiofibular syndesmosis injury of ankle fractures.Methods From January 2020 to January 2022,the clinical data of patients with ankle fracture with lower syndesmosis injury in our hospital were collected.According to different fixation methods of syndesmosis,the patients were divided into suture button titanium plate group and single cortical bone screw group.There were 28 cases in the suture button titanium plate group(group A)and 33 cases in the single cortical screw group(group B).The early,mid and long term functional results,lower tibiofibular combined imaging changes,operation time,hospital stay and complications were compared between the two groups,and the risk factors affecting early ankle function were analyzed.Results The ankle motion score of group A(17.2±1.2)was higher than that of group B(15.8±2.3)one month after surgery,and the differences were statistically significant(P=0.005).The AOFAS score of group A was higher than that of group B[91(80-98)vs.80(68-87)]3 months after operation,and the differences were statistically significant(P=0.003).There was no significant difference in AOFAS scores between the two groups at 6 months and 12 months after surgery(P>0.05).At 1 and 3 months after surgery,there was no significant difference between the two groups in the lower tibiofibular space and lower tibiofibular overlap distance(P>0.05).There was no significant difference in operation time,hospital stay and complications between the two groups(P>0.05).Screw fixation was an independent risk factor for ankle motion<15 points 1 month after surgery(P=0.011)and ankle AOFAS score<90 points 3 months after surgery(P=0.032).Conclusions Locking loop titanium plate is as safe and effective as single cortical screw in the treatment of lower tibiofibular syndesmosis injury of ankle fracture.The early functional results of locking loop titanium plate are better than screw fixation,and the medium and long term results are similar.Screw fixation is an independent risk factor affecting the early functional results.
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