[1]韦志坤△ 杨芳 邵菲 杨金杰 任少海.下胫腓联合分离固定和未固定对踝关节骨折的影响[J].中国中医骨伤科杂志,2020,28(01):23-27.
　WEI Zhikun YANG Fang SHAO Fei YANG Jinjie REN Shaohai.Effect of Distal Tibiofibular Syndesmosis Separation and Fixation and Non-fixation on Ankle Fracture[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(01):23-27.
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下胫腓联合分离固定和未固定对踝关节骨折的影响()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年01期
页码:
23-27
栏目:
临床研究
出版日期:
2020-01-15

文章信息/Info

Title:
Effect of Distal Tibiofibular Syndesmosis Separation and Fixation and Non-fixation on Ankle Fracture
文章编号:
1005-0205(2020)01-0023-05
作者:
韦志坤1△ 杨芳2 邵菲1 杨金杰1 任少海1
1河北省邯郸市第一医院骨五科(河北 邯郸,056000) 2河北省邯郸市中心医院内分泌二科
Author(s):
WEI Zhikun1△ YANG Fang2 SHAO Fei1 YANG Jinjie1 REN Shaohai1
1Department of 5th Orthopedics,Handan First Hospital,Handan 056000,Hebei China; 2Department of 2nd Endocrinology,Handan Central Hospital,Handan 056000,Hebei China.
关键词:
踝关节骨折;  下胫腓联合分离;  内固定;  踝关节活动度;  骨折愈合时间
Keywords:
ankle fracture;  lower tibial combination separation;  internal fixation;  ankle mobility;  fracture healing time
分类号:
R683.42
文献标志码:
A
摘要:
目的:探讨下胫腓联合分离固定和未固定对踝关节骨折患者复位效果、踝关节活动度及愈合时间的影响。方法:将2014年10月至2018年2月在邯郸市第一医院接受治疗的155例踝关节骨折患者分为两组,对照组77例行单纯内外踝及后踝骨折钢板内固定术,观察组78例行内外踝及后踝骨折钢板内固定术联合下胫腓螺钉固定术,术后随访1年,记录患者完全负重时间和骨折愈合时间,采用视觉模拟评分法(VAS)评估患者术前及术后1,3,6,12个月疼痛情况,术前及术后1个月和12个月测量下胫腓间隙(TBCS)和下胫腓重叠距离(TBOL),术后12个月比较患者踝关节活动度,采用Mazur踝关节评分分级系统评估临床疗效。结果:两组患者术后切口均Ⅰ期愈合,未出现切口感染、皮肤坏死等手术相关并发症。随访期间,X线片检查均未发生内固定物松动、断裂,骨不连,延迟愈合等情况。观察组术后完全负重时间长于对照组,差异有统计学意义(P<0.05),两组骨折愈合时间,TBCS,TBOL,Mazur总评分及优良率差异均无统计学意义(P>0.05); 术后1个月和3个月,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05); 术后12个月,观察组踝关节背屈、跖屈、外翻、内翻活动度均大于对照组,差异有统计学意义(P<0.05)。结论:下胫腓联合分离固定与不固定手术治疗踝关节骨折在复位效果和骨折愈合时间方面无明显差异,但下胫腓联合分离固定更有利于踝关节活动度恢复。
Abstract:
Objective:To investigate and analyze the efficacy of distal tibiofibular syndesmosis separation with fixation and non-fixation on reduction effect,ankle motion and healing time of ankle fracture patients.Methods:One hundred-fifty-five patients with ankle fracture treated in Handan First Hospital from October 2014 to February 2018 were randomly divided into two groups,77 cases in the control group were treated with plate internal fixation of internal and external malleolus and posterior malleolus fractures,78 cases in the observation group was treated with plate internal fixation of internal and external malleolus and posterior malleolus fractures combined with lower tibiofibular screw fixation.All patients were followed up for one year after surgery.The complete weight-bearing time and fracture healing time were recorded,visual analogue scale(VAS)was used to evaluate the pain before operation and 1,3,6 and 12 months after operation.The distances between the tibiofibular space(TBCS)and the tibiofibular overlap(TBOL)were measured before operation and 1,12 months after the operation,the ankle mobility was compared 12 months after operation,Mazur ankle scoring and grading system was used to evaluate the clinical efficacy.Results:The incision healed in the I stage after operation in both groups,and there were no operative complications such as wound infection and skin necrosis.During the follow-up period,no internal fixator loosening,fracture,nonunion and delayed healing occurred in X-ray examination.The total weight-bearing time of the observation group was longer than that of the control group after operation(P<0.05),there was no significant difference in fracture healing time,TBCS,TBOL,Mazur total score and excellent and good rate between the two groups(P>0.05).The VAS score of the observation group was lower than that of the control group at 1 and 3 months after operation(P<0.05).At 12 months after operation,the ankle dorsiflexion,plantar flexion,valgus and varus mobilities in the observation group were higher than those in the control group(P<0.05).Conclusion:For patients with ankle fracture,there was no significant difference in reduction effect and fracture healing time between lower tibial combination separation and fixation with unfixed operation,but fixation for lower tibial combination separation was more conducive to recovery of ankle motion.

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备注/Memo

备注/Memo:
基金项目:邯郸市科学技术研究与发展计划项目(1723208066-11)△通信作者 E-mail:weizhikun849@163.com(收稿日期:2019-06-09)
更新日期/Last Update: 2020-01-15