直视下精准复位法治疗下胫腓联合损伤的临床疗效分析

Efficacy of direct vision precise reduction for lower tibiofibular joint injury

关键词:  下胫腓联合损伤  闭合复位  直视下精准复位  复位不良

Key words:  lower tibiofibular joint injury  closed reduction  accurate reduction under direct vision  poor reduction

摘要:

目的通过与闭合复位法对比分析,观察直视下精准复位法治疗下胫腓联合韧带损伤的疗效。 方法前瞻性分析2020年6月—2023年6月复旦大学附属中山医院青浦分院骨科收治并符合选择标准的60例踝关节骨折伴下胫腓联合韧带损伤患者临床资料,其中30例采用闭合复位固定（闭合组）,30例采用直视下参照解剖标志点精准复位下胫腓联合脱位（直视组）。记录并比较两组一般资料如年龄、性别、受伤机制、固定下胫腓联合的手术时间、手术出血量、透视次数、下胫腓间隙（tibiofibular bottom clearance, TBCS)、下胫腓重叠影(tibiofibular overlap, TBOL)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足评分、优良率和并发症发生率。 结果闭合组固定下胫腓联合的手术时间、手术出血量、透视次数分别为（18.23±0.58）min、（84.37±1.83）mL、（9.47±0.26）次,直视组固定下胫腓联合的手术时间、手术出血量、透视次数分别为（16.00±0.55）min、（74.5±1.61）mL、（7.97±0.23）次,两组上述三项围手术期指标比较差异均有统计学意义（P＜0.05）。术前TBCS、TBOL两组比较差异均无统计学意义（P＞0.05）,两组患者术前观察指标无差异,具有可比性；术后TBCS、TBOL两组比较,闭合组分别是（3.16±0.04）mm、（7.77±0.03）mm,直视组分别是（2.98±0.05）mm、（7.92±0.04）mm差异均有统计学意义（P<0.05）；直视组的优良率为96.70%,闭合组的优良率为73.30%,直视组显著高于闭合组组,差异有统计学意义（P＜0.05）。闭合组并发症发生率为26.70%,直视组并发症发生率仅为6.70%,两组并发症发生率差异具有统计学意义（P＜0.05）。 结论直视下精准复位下胫腓联合脱位治疗下胫腓联合损伤疗效确切,显著缩短手术时间及透视次数、改善患者预后功能,是一种有效治疗下胫腓联合损伤的方法。

Abstract:

ObjectiveTo investigate the efficacy of direct vision precise reduction in the treatment of lower tibiofibular syndesmosis injury by comparing with closed reduction method. MethodsThe clinical data of 60 patients with ankle fracture and lower tibiofibular syndesmosis injury admitted to our hospital from June 2020 to June 2023 were retrospectively analyzed. Among them, 30 cases were treated with closed reduction fixation(closed group) and 30 cases were treated with precise reduction of lower tibiofibular syndesmosis with reference to anatomic markers under direct vision(direct vision group). The age, sex, injury mechanism, operation time, volume of intraoperative blood loss, number of fluoroscopy, tibiofibular bottom clearance(TBCS), tibiofibular overlap(TBOL), American Orthopaedic Foot and Ankle Society（AOFAS) Ankle-posterior foot score, excellent and good rate and complication rate were compared between the two groups. ResultsIn the closed group, the operative time, intraoperative blood loss and fluoroscopy times were (18.23±0.58)min, (84.37±1.83)mL and (9.47±0.26)times, while those in the direct vision group were (16.00±0.55)min, (74.5±1.61)mL and (7.97±0.23)times, respectively; there were significant differences in above indexes between the two groups(P<0.05). There was no significance in preoperative TBCS, TBOL and other indicators between the two groups(P>0.05); after surgery, the TBCS and TBOL in the closed group was (3.16±0.04)mm and (7.77±0.03)mm, and those in the open group was (2.98±0.05)mm and (7.92±0.04)mm, respectively (P<0.05). The excellent and good rate of the open vision group was significantly higher than that of the closed group (96.70% vs 73.30%, P<0.05). The incidence of complications in the direct vision group was significantly lower than that in the closed group (6.7% vs 26.70%, P<0.05). ConclusionPrecise reduction of lower tibiofibular combined with dislocation under direct vision is effective in the treatment of lower tibiofibular combined injury, which can significantly shorten the operation time, reduce fluoroscopy times, and improve the prognosis of patients.