Endobutton钢板与皮质骨螺钉治疗伴踝关节骨折的急性下胫腓联合损伤的比较

摘要

目的 比较两种内固定方法治疗伴踝关节骨折的急性下胫腓联合损伤疗效.方法 回顾性分析66例伴踝关节骨折的急性下胫腓联合损伤的病例.其中31例接受Endobutton钢板治疗,35例接受皮质骨螺钉治疗.首先将两种疗法与术前指标作为自变量,治疗结果作为因变量作Logistic回归分析,再分别对两组术中出血量、手术时间、术后负重时间、术后1年下胫腓联合间隙(TBCS)、术后1年胫腓重叠影(TBOL)、AOFAS评分及并发症行统计学分析.结果 性别为影响治疗结果的独立危险因素,而不同治疗方法与结果并无明显相关性.两组资料术中出血量(t=0.543,P=0.589)、术后1年TBCS(t=0.025,P=0.980)、术后1年TBOL(t=0.711,P=0.480)、AOFAS评分(t=0.577,P=0.566)及术后并发症(χ2=0.020,P=0.888)差异无统计学意义.手术时间(t=2.203,P=0.031)Endobutton钢板组较长,但术后负重时间(t=-18.459,P<0.001)Endobutton钢板组较短,且均差异有统计学意义.结论 Endobutton钢板与皮质骨螺钉治疗伴踝关节骨折的急性下胫腓联合损伤疗效上无明显统计学差异,基本不需二次手术取出,术前应综合考虑,慎重选择内固定.%Objective To compare the effects of these two kinds of internal fixation methods in the treatment of acute injury of distal tibiofibular syndesmosis.Methods Retrospective analysis was made of 66 cases of acute injury of distal tibiofibular syndesmosis.Thirty-one patients received endobutton fixation and 35 patients received cortical screws treatment.Two methods were used with preoperative indicators as independent variables,and the results were treated as the dependent variables for Logistic regression analysis.Two methods were compared in mean blood loss,operation time,burdened time,TBCS (One Year Post-operation),TBOL (One Year Post-operation),AOFAS score and rate of complications.Results By comparison,we found that gender was an independent risk factor for treatment outcome,but there was no significant correlation between different methods and outcomes.The differences were not statistically significant in mean blood loss (t=0.543,P=0.589),TBCS (One Year Post-operation)(t=0.025,P=0.980),TBOL (One Year Post-operation) (t=0.711,P=0.480),AOFAS score(t=0.577,P=0.566) and rate of complications (χ2=0.020,P=0.888).And the operation time of treatment by Endobutton fixation was longer than that of treatment by cortical screws (t=2.203,P=0.031).The weight bearing time of treatment by endobutton fixation was shorter than that of treatment by cortical screws (t=-18.459,P<0.001).There was statistical significance between these two methods.Conclusions There was no significant difference between these two methods in the treatment of acute injury of distal tibiofibular syndesmosis.The appropriate method should be considered before operation.