目的:比较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的临床效果.方法:对2014年5月至2016年2月采用锁扣带袢钛板重建和传统螺钉固定治疗的68例踝关节骨折伴下胫腓联合损伤患者的临床资料进行回顾性分析.根据治疗方法分为锁扣带袢钛板组和传统螺钉组,锁扣带袢钛板组33例采用锁扣带袢钛板重建下胫腓联合,其中男18例,女15例;年龄20～55岁,平均(32.4±5.2)岁;Lauge-Hansen分型为旋前外旋Ⅲ度12例,Ⅳ度21例.传统螺钉组35例采用传统螺钉固定下胫腓联合治疗,其中男19例,女16例;年龄21～54岁,平均(32.8±5.5)岁;Lauge-Hansen分型为旋前外旋Ⅲ度13例,Ⅳ度21例,旋前外展1例.观察并比较两组患者手术复位固定下胫腓联合的时间、并发症情况,并于术后3、6个月及末次随访采用AOFAS评分进行功能评价.结果:所有病例获得随访,时间8～ 24个月,平均(16.3±3.8)个月.下胫腓联合固定时间锁扣带袢钛板组(10.1±2.8) min,传统螺钉组(9.5±2.3) min,两组比较差异无统计学意义(P＞0.05).两组患者并发症比较差异有统计学意义(P＜0.05).两组患者术后3、6个月AOFAS评分比较差异有统计学意义(P＜0.05).末次随访锁扣带袢钛板组优23例,良9例,中1例;传统螺钉组优18例,良12例,中5例;两组比较差异无统计学意义(P＞0.05).结论:锁扣带袢钛板治疗下胫腓联合韧带损伤,操作方便,可早期负重锻炼而无断钉风险,为治疗踝关节骨折伴下胫腓联合损伤提供了新的选择.但仍需进一步研究总结纽扣钢板置入的角度、方向及张力的调节.%Objective:To compare the clinical effectiveness for Tight rope fixation and traditional screw fixation in treating injury of distal tibiofibular syndesmosis in ankle fractures.Methods:A retrospective study was carried out in patients with injury of distal syndesmosis in ankle fractures who received 2 surgical operations (observation group:33 cases with Tight rope fixation;control group:35 cases with traditional screw fixation) from May 2014 to February 2016.There were 18 males and 15 females,aged from 20 to 55 years old with an average of (32.4±5.2) years old in observation group;of them,19 cases were caused by traffic accidents,10 by sprain,and 4 by falling;according to Lauge-Hansen typing of ankle fractures,all of the 33 cases were pronation-extorsion fracture,12 cases were Ⅲ degree and 21 cases were ⅣV degree.There were 19 males and 16 females,aged from 21 to 54 years old with an average of (32.8±5.5) years old in control group;of them,20 cases were caused by traffic accidents,11 by sprain,4 by falling;according to Lauge-Hansen typing of ankle fractures,1 case was with pronationoutreach,34 cases with pronation-extorsion,13 cases were Ⅲ degree and 21 cases were ⅣV degree.Fixation time and complication were compared between two groups and AOFAS scores were observed in two groups 3 and 6 months after the operation as well as final follow-up.Results:All the patients were followed up from 8 to 24 months with an average of (16.3±3.8) months.Fixation time of observation group and control group were (10.1±2.8) min and (9.5±2.3) min (P＞0.05) respectively.There were significant difference in complication and AOFAS of 3,6 months postoperatively between two groups (P＜O.05).In observation group,23 case got excellent result,9 good,1 fair;and in control group,18 cases got excellent resuhs,12 good,5 fair;there was no significant difference between two groups (P＞0.05).Conclusion:Tight rope for the treatment of injury of distal tibiofibular ligament union in ankle fractures has advantages such as easier techniques,earlier weight-bearing exercises without risk of screw breakage,thus is a new choice.However,it is still necessary to further study the angle,direction and tension of button steel plate.
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