中医正骨2025，Vol.37Issue(3)：39-45,7.
TightRope带袢钢板内固定与皮质骨螺钉内固定治疗踝关节骨折合并的下胫腓联合损伤的对比研究
A comparative study of TightRope loop steel plate versus cortical bone screw internal fixation in treatment of distal tibiofibular syndesmosis injuries associated with ankle fractures
摘要
Abstract
Objective:To compare the clinical efficacy and safety of TightRope loop steel plate versus cortical bone screw internal fixa-tion in treatment of distal tibiofibular syndesmosis(DTFS)injuries associated with ankle fractures.Methods:The medical records of 110 pa-tients who underwent internal fixation surgery for DTFS injuries associated with ankle fractures at The First Hospital of Handan from March 2021 to April 2023 were retrospectively analyzed.Fifty-six patients were treated with TightRope loop steel plate internal fixation(loop steel plate group),while the others with cortical bone screw internal fixation(screw group).The intraoperative time consuming for fixation of DTFS,intraoperative blood loss,postoperative hospital stays,postoperative full weight-bearing walking start time,distal tibiofibular clear space,distal tibiofibular overlap distance,ankle function,distal tibiofibular re-separation incidence and complication incidence were com-pared between the 2 groups.Results:The postoperative full weight-bearing walking start time was shorter in loop steel plate group compared to screw group(8.36±2.41 vs 10.57±2.69 weeks,t=4.542,P=0.000),while,the intraoperative time consuming for fixation of DTFS,intraoperative blood loss and postoperative hospital stays were not statistical significant between the 2 groups.The distal tibiofibular clear space decreased over time in the 2 groups(8.05±2.39,3.78±0.84,3.66±0.72,3.63±0.70 mm,F=143.478,P=0.000;7.78±2.14,3.63±0.79,3.58±0.64,3.57±0.67 mm,F=156.160,P=0.000),while the distal tibiofibular overlap distance presented a trend of increased initially and decreased subsequently over time in the 2 groups(1.72±0.52,9.06±1.94,8.93±1.81,8.91±1.78 mm,F=280.745,P=0.000;1.87±0.56,8.85±1.81,8.79±1.77,8.75±1.72 mm,F=267.660,P=0.000),and the 2 groups were consistent with each other in the variation tendency.At postsurgical month 3 and 6,the range of motions(ROMs)including dorsal ex-tension and plantar flexion were greater,and the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was higher in loop steel plate group compared to screw group(5.26±1.14 vs 4.82±0.95 degrees,t=2.195,P=0.030;9.11±1.18 vs 8.47±1.23 degrees,t=2.785,P=0.006;17.58±2.92 vs 16.09±3.13 degrees,t=2.583,P=0.011;27.83±2.61 vs 26.58±2.37 degrees,t=2.627,P=0.010;68.29±10.45 vs 64.11±9.03 points,t=2.241,P=0.027;83.46±7.20 vs 79.78±8.64 points,t=2.430,P=0.017).After the surgery,the distal tibiofibular re-separation was found in 1 patient in loop steel plate group and 2 patients in screw group.There was no statistical difference in the distal tibiofibular re-separation incidence between the 2 groups(x2=0.001,P=0.975).Besides,the incision infection was found in loop steel plate group and screw group in 2 patients,respectively,and the internal fixation loosening was found in 1 patient in loop steel plate group and 3 patients in screw group.There was no statistical difference in the complication incidence between the 2 groups(x2=0.227,P=0.634).Conclusion:Both TightRope loop steel plate internal fixation and cortical bone screw inter-nal fixation can achieve good reduction and fixation effects in treatment of DTFS injuries associated with ankle fractures,and the both are comparable in surgical injury and safety,while the former displays the advantages of earlier full weight-bearing and better ankle function re-covery after the surgery compared to the latter.关键词
踝骨折/下胫腓联合损伤/骨折固定术,内/骨螺丝/TightRope带袢钢板Key words
ankle,fractures/distal tibiofibular syndesmosis injuries/fracture fixation,internal/bone screws/TightRope loop steel plate引用本文复制引用
安彪,范小波..TightRope带袢钢板内固定与皮质骨螺钉内固定治疗踝关节骨折合并的下胫腓联合损伤的对比研究[J].中医正骨,2025,37(3):39-45,7.基金项目
河北省医学科学研究课题计划项目(20231919) （20231919）
