苏忠良 阮国模 傅家兴 游逸丰 郑元波

带袢纽扣钢板与螺钉治疗下胫腓
联合分离的对照研究

苏忠良 阮国模 傅家兴 游逸丰 郑元波

目的 比较带袢纽扣钢板和踝穴上横行螺钉固定治疗下胫腓联合分离的临床疗效。方法 对近3年收治的39例下胫腓联合分离患者分别采用带袢纽扣钢板治疗（20例，A组），踝穴上横行螺钉固定（19例，B组）。观察并比较两组的手术时间、部分及完全负重时间、踝关节活动度、胫骨前结节与腓骨重叠影（TFO）、下胫腓联合间隙（TFCS）、踝关节功能评分（AOFAS）及并发症发生情况。结果 A组手术时间长于B组，部分负重及完全负重时间均少于B组，差异均有统计学意义（均P＜0.05）。两组均发生创口感染1例，但B组发生内固定断裂4例，下胫腓联合再分离1例，A组总的并发症发生率低于B组，差异有统计学意义（P＜0.05）；两组踝关节活动度、TFO、TFCS及AOFAS功能评分的差异均无统计学意义（均P＞0.05）。结论 带袢纽扣钢板和踝穴上横行螺钉固定治疗下胫腓联合分离均可取得良好效果，但带袢纽扣钢板治疗具有患者术后早负重、并发症少、无需二次手术等优点，是治疗下胫腓联合分离的较好选择。

带袢纽扣钢板 螺钉 下胫腓联合 分离

【 Abstract】 Objective To compare the clinical effect of distal tibiofibular syndesmosis disruption treated with endobutton and traditional screw. Methods Thirty nine patients with distal tibiofibular syndesmosis disruption were randomized into two groups,20 cases in group A were treated with endobutton,and 19 cases in group B were treated with traditional screw fixation. The data of operation time,weight-bearing time,ROM,TFO,TFCS,AOFAS scores and occurrence of the complications were compared between two groups. Results The operation time in group A was longer than group B,while the weight-bearing time in group A was shorter(both P＜0.05).There was no significant difference in ROM,TFO,TFCS,and AOFAS scores(all P＞0.05), but the incidence of complications in group A was lower than in group B（all P＜0.05).Wound infection ocurred in one patient in each group.There were four fixation broken and one late diastasis case in group B. Conclusion Both endobutton and traditional screw fixation can lead to good clinical outcomes.With the advantages of early weight-bearing,less complications,and no need to remove the implant,the endobutton therapy is good option for distal tibiofibular syndesmosis disruption.

下胫腓联合分离是踝关节骨折和脱位的常见并发损伤[1]，正确的诊断和治疗对患者的功能恢复至关重要。目前常用治疗方案有踝穴上横行螺钉固定、钩钢板固定等[2-3]，但这些都属于刚性固定，术后常出现内固定断裂、下胫腓联合再分离等并发症。近年来不少学者采用带袢纽扣钢板治疗肩锁关节脱位取得良好疗效，证明了带袢纽扣钢板重建韧带的良好效果[4-5]。……