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[1]安彪,范小波.TightRope带袢钢板内固定与皮质骨螺钉内固定治疗踝关节骨折合并的下胫腓联合损伤的对比研究[J].中医正骨,2025,37(03):39-45.
AN Biao,FAN Xiaobo.A comparative study of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis injuries associated with ankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(03):39-45.
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TightRope带袢钢板内固定与皮质骨螺钉内固定治疗踝关节骨折合并的下胫腓联合损伤的对比研究()
《中医正骨》[ISSN:1001-6015/CN:41-1162/R]
卷:
第37卷
期数:
2025年03期
页码:
39-45
栏目:
临床研究
出版日期:
2025-03-20
文章信息/Info
Title:
A comparative study of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis injuries associated with ankle fractures
作者:
安彪; 范小波
邯郸市第一医院,河北 邯郸 056004
Author(s):
AN Biao; FAN Xiaobo
The First Hospital of Handan,Handan 056004,Hebei,China
关键词:
踝骨折; 下胫腓联合损伤; 骨折固定术; 内; 骨螺丝; TightRope带袢钢板
Keywords:
ankle; fractures; distal tibiofibular syndesmosis injuries; fracture fixation; internal; bone screws; TightRope loop steel plate
摘要:
目的:比较TightRope带袢钢板内固定和皮质骨螺钉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:回顾性分析2021年3月至2023年4月,在邯郸市第一医院接受内固定手术治疗的110例踝关节骨折合并下胫腓联合损伤患者的病例资料,其中下胫腓联合损伤采用TightRope带袢钢板内固定56例(带袢钢板组)、采用皮质骨螺钉内固定54例(螺钉组)。比较2组患者术中下胫腓联合固定用时、术中失血量、术后住院天数、术后完全负重时间、下胫腓间隙、下胫腓重叠距离、踝关节功能,以及下胫腓再分离和并发症发生情况。结果:带袢钢板组术后完全负重时间早于螺钉组[(8.36±2.41)周,(10.57±2.69)周,t=4.542,P=0.000],但2组患者术中下胫腓联合固定用时、术中失血量、术后住院天数的组间差异均无统计学意义。2组患者下胫腓间隙均随时间变小[(8.05±2.39)mm,(3.78±0.84)mm,(3.66±0.72)mm,(3.63±0.70)mm,F=143.478,P=0.000;(7.78±2.14)mm,(3.63±0.79)mm,(3.58±0.64)mm,(3.57±0.67)mm,F=156.160,P=0.000],下胫腓重叠距离均随时间呈先增加后减小的趋势[(1.72±0.52)mm,(9.06±1.94)mm,(8.93±1.81)mm,(8.91±1.78)mm,F=280.745,P=0.000;(1.87±0.56)mm,(8.85±1.81)mm,(8.79±1.77)mm,(8.75±1.72)mm,F=267.660,P=0.000],且2组的变化趋势均一致。术后3个月和术后6个月,带袢钢板组踝关节背伸和跖屈活动度均大于螺钉组[5.26°±1.14°,4.82°±0.95°,t=2.195,P=0.030; 9.11°±1.18°,8.47°±1.23°,t=2.785,P=0.006; 17.58°±2.92°,16.09°±3.13°,t=2.583,P=0.011; 27.83°±2.61°,26.58°±2.37°,t=2.627,P=0.010],美国足与踝关节协会踝与后足评分均高于螺钉组[(68.29±10.45)分,(64.11±9.03)分,t=2.241,P=0.027;(83.46±7.20)分,(79.78±8.64)分,t=2.430,P=0.017]。术后带袢钢板组发生下胫腓再分离1例,螺钉组发生下胫腓再分离2例,2组患者下胫腓再分离发生率的差异无统计学意义(χ2=0.001,P=0.975); 带袢钢板组并发切口感染2例、内固定松动1例,螺钉组并发切口感染2例、内固定松动3例,2组患者并发症发生率的差异无统计学意义(χ2=0.227,P=0.634)。结论:对于踝关节骨折合并下胫腓联合损伤患者,采用TightRope带袢钢板内固定和皮质骨螺钉内固定下胫腓联合,均能获得良好的复位固定效果,二者在手术损伤和安全性方面相当,但前者术后完全负重时间更早,踝关节功能恢复更好。
Abstract:
Objective:To compare the clinical efficacy and safety of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis(DTFS)injuries associated with ankle fractures.Methods:The medical records of 110 patients who underwent internal fixation surgery for DTFS injuries associated with ankle fractures at The First Hospital of Handan from March 2021 to April 2023 were retrospectively analyzed.Fifty-six patients were treated with TightRope loop steel plate internal fixation(loop steel plate group),while the others with cortical bone screw internal fixation(screw group).The intraoperative time consuming for fixation of DTFS,intraoperative blood loss,postoperative hospital stays,postoperative full weight-bearing walking start time,distal tibiofibular clear space,distal tibiofibular overlap distance,ankle function,distal tibiofibular re-separation incidence and complication incidence were compared between the 2 groups.Results:The postoperative full weight-bearing walking start time was shorter in loop steel plate group compared to screw group(8.36±2.41 vs 10.57±2.69 weeks,t=4.542,P=0.000),while,the intraoperative time consuming for fixation of DTFS,intraoperative blood loss and postoperative hospital stays were not statistical significant between the 2 groups.The distal tibiofibular clear space decreased over time in the 2 groups(8.05±2.39,3.78±0.84,3.66±0.72,3.63±0.70 mm,F=143.478,P=0.000; 7.78±2.14,3.63±0.79,3.58±0.64,3.57±0.67 mm,F=156.160,P=0.000),while the distal tibiofibular overlap distance presented a trend of increased initially and decreased subsequently over time in the 2 groups(1.72±0.52,9.06±1.94,8.93±1.81,8.91±1.78 mm,F=280.745,P=0.000; 1.87±0.56,8.85±1.81,8.79±1.77,8.75±1.72 mm,F=267.660,P=0.000),and the 2 groups were consistent with each other in the variation tendency.At postsurgical month 3 and 6,the range of motions(ROMs)including dorsal extension and plantar flexion were greater,and the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was higher in loop steel plate group compared to screw group(5.26±1.14 vs 4.82±0.95 degrees,t=2.195,P=0.030; 9.11±1.18 vs 8.47±1.23 degrees,t=2.785,P=0.006; 17.58±2.92 vs 16.09±3.13 degrees,t=2.583,P=0.011; 27.83±2.61 vs 26.58±2.37 degrees,t=2.627,P=0.010; 68.29±10.45 vs 64.11±9.03 points,t=2.241,P=0.027; 83.46±7.20 vs 79.78±8.64 points,t=2.430,P=0.017).After the surgery,the distal tibiofibular re-separation was found in 1 patient in loop steel plate group and 2 patients in screw group.There was no statistical difference in the distal tibiofibular re-separation incidence between the 2 groups(χ2=0.001,P=0.975).Besides,the incision infection was found in loop steel plate group and screw group in 2 patients,respectively,and the internal fixation loosening was found in 1 patient in loop steel plate group and 3 patients in screw group.There was no statistical difference in the complication incidence between the 2 groups(χ2=0.227,P=0.634).Conclusion:Both TightRope loop steel plate internal fixation and cortical bone screw internal fixation can achieve good reduction and fixation effects in treatment of DTFS injuries associated with ankle fractures,and the both are comparable in surgical injury and safety,while the former displays the advantages of earlier full weight-bearing and better ankle function recovery after the surgery compared to the latter.
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相似文献/References:
[1]包学迅,王贺辉,郁耀平,等.TightRope钢板内固定治疗三踝骨折合并下胫腓联合损伤[J].中医正骨,2017,29(08):65.
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备注/Memo:
基金项目:河北省医学科学研究课题计划项目(20231919)通讯作者:范小波 E-mail:fxb13931029970@163.com
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