目的 探讨合并有下胫腓联合损伤的踝关节骨折脱位中应用弹性固定下胫腓联合损伤的临床疗效.方法 踝关节骨折脱位患者42例,分为观察组(弹性固定)20例与对照组(螺钉固定)22例.比较两组手术时间、术中出血量、术后AOFAS踝-后足评分.结果 所有患者均至少随访1年.两组间年龄及性别组成、术中出血量、及手术时间差异无统计学意义(P>0.05).对照组1例出现螺钉断裂,所有患者未出现迟发性的下胫腓联合分离.对照组未出现螺钉松动、退出等情况.观察组未出现纽扣钢板内陷及骨道增宽等情况.两组术后6、12个月行AOFAS踝-后足评分,优良率差异无统计学意义(P<0.05).结论 在踝关节骨折脱位合并有需手术干预的下胫腓联合损伤中,应用螺钉固定及弹性固定均能取得良好效果,但采用弹性固定下胫腓联合是一种更符合生理的固定方式,对踝关节功能影响小,有利于早期康复训练,避免不必要的附加拆除手术.%Objective To investigate the clinical effect of flexible fastening in the treatment of anklebone fractures disposition with distal tibiofibular syndesmosis injuries. Methods This investigation presented a prospective study of 42 patients who with distal tibiofibular syndesmosis injuries and needed surgery. They were divided into experimental group(flexible fastening)and control group(non-flexible fastening)by using the completely randomized digital.There were 22 cases in the control group and 20 cases in experimental group. The age,gender composition before the operation,and the operation time,the hemorrhage volume during the operations,the AOFAS scores after the operation we compared between the two groups. Result All patients were followed up for at least 1 years.In the control group,1 cases of screw breakage occurred. No one had delayed separation of distal tibiofibular syndesmosis .Loosening and pullout of screw had not happened in the control group . The button invagination and bone channel broadening had not happened in the experimental group .The AOFAS score had no different between the two groups at the sixth and twelfth months after the operation. Conclusion The flexible fastening has a similar outcome compared with the non-flexible fastening in treatment of distal tibiofibular syndesmosis injury ,but may be more consistent with sport biomechanics and less effects in ankle function,leads to a quicker rehabilitation training and no additional operation.
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