TightRope与金属螺钉内固定治疗下胫腓联合分离的临床疗效对比

目的探讨锁扣带袢钛板(Tight Rope)内固定与金属螺钉内固定2种术式治疗下胫腓联合分离的临床疗效。方法笔者自2012-01—2016-03采用Tight Rope(Tight Rope组)与金属螺钉(金属螺钉组)2种内固定术式治疗46例下胫腓联合分离伴或不伴踝关节骨折。分别记录2组术前、术后即刻、术后3个月、末次随访时后前位X线片上下胫腓间隙(TBCS)、下胫腓重叠距离(TBOL),观察比较2组术后VAS评分、部分负重时间、完全负重时间、AOFAS踝与后足功能评分。结果 2组手术均顺利完成,术后切口均一期愈合,均获得平均14(11~18)个月随访。2组术前、术后即刻、术后3个月、末次随访时TBCS、TBOL差异无统计学意义(P0.05);2组术后3 d VAS评分差异无统计学意义(P0.05);Tight Rope组术后部分负重时间及完全负重时间均少于金属螺钉组,差异有统计学意义(P0.05);Tight Rope组术后3个月及6个月的AOFAS踝与后足评分高于金属螺钉组,差异有统计学意义(P0.05),2组末次随访时AOFAS踝与后足功能评分差异无统计学意义(P0.05)。金属螺钉组出现1例螺钉弯曲、1例螺钉断裂,Tight Rope组无内固定松动、断裂等并发症。2组均无下胫腓联合再次分离、踝关节再次骨折等并发症。结论 Tight Rope内固定与螺钉内固定均为治疗下胫腓联合分离的可靠性方法;Tight Rope组可早期功能锻炼及下地负重,踝关节功能恢复较金属螺钉组更有优势。

Comparison of clinical efficacy between TightRope and metal screw fixation for syndesmotic tibiofibular diastasis

Objective To investigate the clinical efficacy of TightRope and metal screw fixation for syndesmotic tibiofibular diastasis.Methods Forty six cases of separation of tibiofibular syndesmosis with or without ankle fractures were treated with two internal fixation operations,TightRope (the TightRope group) and metal screw (metal screw group).The lower tibiofibular clear space (TBCS) and the lower tibiofibular overlap (TBOL) were recorded respectively before and after operation,3 months after operation and at the last follow-up.The VAS pain score,partial load time,full load time as well as AOFAS ankle-hind foot score were compared.Results All patients in two groups had successful operations and the incision was healed by first intention.All patients were followed up for an average of 14 (11-18)months.There was no significant difference in TBCS and TBOL between the two groups before the operation,immediately and three months after operation and at the last follow-up(P ＞ 0.05).There was no significant difference in VAS score three days after operation between the two groups (P ＞0.05);Partial load time and full load time of the TightRope group was less than the mental screw group and there was significant difference (P ＜0.05).The AOFAS ankle-hind foot score 3 months and 6 months after operation in the TightRope group were higher than those of the metal screw group and there was statistical difference (P ＜0.05).There was no significant difference in AOFAS ankle-hind foot score at the last follow-up between the two groups (P ＞0.05).One screw bending and one screw breakage occurred in the mental screw group while there was no complication like internal fixation loose and breakage in the TightRope group.No lower tibiofibular joint re-separation,ankle re-fracture or other complications happened.Conclusion Both the internal fixation using TightRope and the internal fixation using screw are reliable methods for the treatment of syndesmotic tibiofibular diastasis;however,the patients in locking strap titanium plate group (TightRope) have more advantages in terms of early functional exercise,weight loading and ankle function recovery compared with the screw group.