不同固定术治疗下胫腓联合损伤的效果观察

doi:10.3969/j.issn.1006-6233.2021.12.025

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摘要 目的: 观察尼斯结弹性固定与螺钉刚性固定在治疗下胫腓联合损伤的效果。方法: 回顾性分析2019年12月至2020年12月我院收治的167例下胫腓联合损伤患者,其中80例采用全螺纹螺钉(螺钉组)固定下胫腓联合,87例通过尼斯结(NICE结组)固定下胫腓联合,比较术中胫腓固定时间、术中出血量、伤口愈合时间以及术后两组患者行走与负重时间(下地行走世间、部分负重时间、完全负重时间),比较手术前及术后6个月足踝评分、踝关节评分、背屈角度、跖屈角度以及随访半年两组患者并发症发生情况。结果: 术中,NICE结组下胫腓固定时间显著低于螺钉组(P<0.05),出血量和伤口显著愈合时间无显著差异(P>0.05);术后,NICE结组患者下地行走时间、部分负重时间、完全负重时间显著早于螺钉组(P<0.05);手术治疗6个月后,两组患者足踝评分(AOFAS)、踝关节评分(Kofoed)较术前显著提高(P<0.05),且NICE结组评分及评分变化幅度显著高于螺钉组(P<0.05);术后,两组患者背屈角度、跖屈角度较术前显著增大(P<0.05),且NICE结组显著大于螺钉组(P<0.05),跖屈角度变化幅度NICE结组显著高于螺钉组(P<0.05),背屈角度无显著差异(P>0.05);术后随访半年内,NICE结组和螺钉组并发症发生率分别为4.60%、10.00%,差异无统计学意义(P>0.05)。结论: 相较于螺钉固定,NICE结固定下胫腓联合损伤,利于患者早期踝关节功能恢复,并发症低,值得临床推广。

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	陈定中
	王隆辉
	李超艺

关键词 ： NICE结固定, 螺钉固定, 下胫腓联合损伤, 负重时间, 踝关节功能

Abstract：Objective: To observe the effect of Nice knot elastic fixation and screw rigid fixation in the treatment of distal tibiofibular syndesmosis injury. Methods: 167 patients with distal tibiofibular syndesmosis injury admitted to the hospital between December 2019 and December 2020 were retrospectively analyzed. Among them, 80 cases adopted screws to fix distal tibiofibular syndesmosis (screw group) and 87 cases were fixed with NICE knot for distal tibiofibular syndesmosis (NICE knot group). The intraoperative distal tibiofibular fixation time, intraoperative blood loss, wound healing time and postoperative walking time and weight-bearing time (time of walking down the ground, partial weight-bearing time, complete weight-bearing time) were compared between the two groups. Foot ankle score, ankle joint score, angle of dorsiflexion and angle of plantar flexion before surgery and at 6 months after surgery and occurrence of complications at half a year of follow-up were compared. Results: During surgery, the distal tibiofibular fixation time in NICE knot group was significantly shorter than that in screw group (P<0.05), and there were no significant differences in blood loss and significant wound healing time (P>0.05). After surgery, time of walking down the ground, partial weight-bearing time and complete weight-bearing time were significantly earlier in NICE knot group than those in screw group (P<0.05). After 6 months of surgical treatment, the foot ankle score (AOFAS) and ankle score (Kofoed) of the two groups were significantly enhanced compared with those before surgery (P<0.05), and the scores and ranges of score change of NICE knot group were significantly higher than those of screw group (P<0.05). After surgery, the dorsiflexion angle and plantar flexion angle of the two groups were significantly larger than those before surgery (P<0.05), and the two indicators were significantly larger in NICE knot group compared with those in screw group (P<0.05). The change range of plantar flexion Angle in NICE knot group was significantly higher than that in screw group (P<0.05), but there was no significant difference in change range of dorsiflexion angle (P>0.05). Within half a year of postoperative follow-up, the incidence rate of complications was 4.60% in NICE group and was 10.00% in screw group respectively (P>0.05). Conclusion: Compared with screw fixation, NICE knot fixation of distal tibiofibular syndesmosis injury is more beneficial to the early recovery of ankle joint function, and it has lower incidence of complications and is worthy of clinical promotion.

Key words： NICE knot fixation Screw fixation Distal tibiofibular syndesmosis injury Weight-bearing time Ankle joint function

基金资助:海南省自然科学基金项目,(编号:819MS126)

通讯作者: 李超艺

引用本文:

陈定中, 王隆辉, 李超艺. 不同固定术治疗下胫腓联合损伤的效果观察[J]. 河北医学, 2021, 27(12): 2046-2051.
CHEN Dingzhong, WANG Longhui, LI Chaoyi. Different Fixation Methods in the Treatment of Distal Tibiofibular Syndesmosis Injury. HeBei Med, 2021, 27(12): 2046-2051.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.12.025 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I12/2046

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