传统金属拉力钉和高分子可吸收螺钉固定不稳定踝关节骨折的比较

背景：临床治疗下胫腓联合分离型不稳定踝关节骨折可以采用外科内固定方式，内固定过程中可以选择不同的材料，以往大多使用金属拉力钉，但存在断钉等风险。 目的：探讨传统金属拉力钉和高分子可吸收螺钉固定在下胫腓联合分离性不稳定踝关节骨折中的应用效果。 方法：回顾性分析陕西中医药大学附属医院2013年2月至2014年2月收治的63例下胫腓联合分离性不稳定踝关节骨折患者的临床资料，均实施外科内固定治疗，按照所使用材料的不同分为金属拉力钉组32例和可吸收螺钉组31例。于腓骨下段外侧做切口对骨折端予以复位，并利用钢板进行固定，并分别利用传统金属拉力钉和高分子可吸收螺钉进行固定。内固定后随访12个月，观察两组的踝关节功能评分(Baird-Jackson)和临床效果以及不良事件发生情况，并进行比较。 结果与结论：可吸收螺钉组患者平均下地活动时间和内固定后住院天数均显著少于金属拉力钉组(P < 0.05)。两组踝关节功能评分(Baird-Jackson)较固定前均上升，但差异无显著性意义(P > 0.05)。可吸收螺钉组治疗优良率显著高于金属拉力钉组(P < 0.05)。内固定后随访12个月，金属拉力钉组有1例患者出现螺钉断裂，可吸收螺钉组未出现任何不良事件，2组患者均未出现切口感染等情况。结果证实，利用高分子可吸收螺钉固定治疗下胫腓联合分离性不稳定踝关节骨折可以获得较之传统金属拉力钉更好的应用效果。  中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Comparison of traditional metal pulling nail and macromolecule absorbable screw fixation in repair of unstable ankle fractures

BACKGROUND: Clinical treatment of tibiofibular syndesmosis separation of unstable ankle fractures can be treated by surgical internal fixation method. The internal fixation process can choose different materials, in the past, most of the operations used metal pulling nail, but there may be broken nails and other risks. OBJECTIVE: To explore the application effect of traditional metal pulling nail and macromolecule absorbable screw fixation in tibiofibular syndesmosis separation of unstable ankle fracture. METHODS: The clinical data of 63 patients with tibiofibular syndesmosis separation of unstable ankle fractures who received surgical internal fixation treatment in Affiliated Hospital of Shaanxi University of Chinese Medicine from February 2013 to February 2014 were retrospectively analyzed. Patients were divided into metal pulling nail group (n=32) and absorbable screw group (n=31) according to the use of different materials. The fracture end was reset by cutting from the outside of the lower section of the fibula. The steel plate was used for fixation. The traditional metal pull screws and macromolecule absorbable screw were used for fixation. During the 12 months  of follow-up after internal fixation, the ankle function scores of two groups (Baird-Jackson), clinical effect and the incidence of adverse events were observed and compared. RESULTS AND CONCLUSION: The average ambulation time and hospital stay of patients after internal fixation in absorbable screw group were significantly less than those of metal pulling nail group (P < 0.05). The ankle joint function scores (Baird-Jackson) in these two groups were increased compared with those before surgery, but the difference was not significant (P > 0.05). The excellent and good rate of patients in absorbable screw group was significantly higher than that in the metal pulling nail group (P < 0.05). During 12 months of follow-up after internal fixation, one patient had screw breakage in metal pulling nail group. There was no wound infection among patients in these two groups. These results confirm that the use of macromolecule absorbable screw fixation for the treatment of tibiofibular syndesmosis separation of unstable ankle fractures can obtain better application effect compared with the traditional metal pulling nails.