Endobutton带袢钢板弹性固定在踝关节骨折合并下胫腓联合韧带损伤中的应用效果

Effectiveness of Endobutton loop plate elastic fixation in treating ankle fractures combined with distal tibiofibular syndesmosis injury

摘要:

目的 探讨Endobutton带袢钢板弹性固定在踝关节骨折合并下胫腓联合韧带损伤中的应用效果。方法 选取2021年1月—2024年10月宁夏医科大学附属石嘴山市第一人民医院接受治疗的86例踝关节骨折合并下胫腓联合韧带损伤患者作为研究对象。通过随机数字表法将患者分为对照组和观察组，各43例。对照组接受下胫腓螺钉刚性固定，观察组接受Endobutton带袢钢板弹性固定。记录患者的手术时间、术中出血量、切口长度、下床活动时间，比较术前和术后6个月的踝关节活动度（背伸、跖屈、内翻、外翻）、影像学检测指标［胫骨远端前侧关节面角（TAS）、距骨倾斜角（TT）、胫骨踝穴角（TC）、胫骨侧位关节面角（TLS）］，通过美国足踝外科协会（AOFAS）评分、Barthel指数（BI）评估患者的踝关节功能和日常活动能力。记录术后并发症发生情况。结果 两组患者手术时间、术中出血量和切口长度比较，差异均无统计学意义（P >0.05）。观察组下床活动时间短于对照组（P <0.05）。观察组手术后踝关节背伸、跖屈、内翻、外翻角度均大于对照组（P <0.05）。观察组手术前后踝关节背伸、跖屈、内翻、外翻角度的差值均大于对照组（P <0.05）。观察组手术后TAS、TC、TLS均大于对照组（P <0.05），TT小于对照组（P <0.05）。观察组手术前后TAS、TT、TC、TLS的差值均大于对照组（P <0.05）。观察组手术后AOFAS评分、BI指数均高于对照组（P <0.05）。观察组手术前后AOFAS评分、BI指数的差值均大于对照组（P <0.05）。观察组术后并发症发生率低于对照组（P <0.05）。结论 Endobutton带袢钢板弹性固定治疗踝关节骨折合并下胫腓联合损伤较螺钉固定可更好地促进患者早期活动，改善踝关节功能，并减少并发症风险。

Abstract:

Objective To investigate the effectiveness of Endobutton loop plate elastic fixation in the treatment of ankle fractures combined with distal tibiofibular syndesmosis injury.Methods A total of 86 patients with ankle fractures and distal tibiofibular syndesmosis injury admitted to our hospital from January 2021 to October 2024 were enrolled. Patients were divided into a control group (n = 43) and an observation group (n = 43) using the random number table method. The control group underwent rigid fixation with syndesmotic screws, while the observation group received Endobutton loop plate elastic fixation. Perioperative parameters, including operative time, intraoperative blood loss, incision length, and time to ambulation, were recorded. Ankle range of motion (dorsiflexion, plantarflexion, inversion, and eversion), and radiographic parameters including the tibial anterior surface angle (TAS), talar tilt angle (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) before and 6 months after surgery, were compared. Ankle function and activities of daily living were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Barthel Index (BI). Postoperative complications were also recorded.Results Comparison of the observation group and the control group in terms of operative time, intraoperative blood loss, and incision length showed no statistically significant differences (P > 0.05). However, the time to ambulation was shorter in the observation group than that in the control group (P <0.05). Postoperatively, the observation group demonstrated significantly greater ankle range of motion in dorsiflexion, plantarflexion, inversion, and eversion compared with the control group (P < 0.05). The changes in these angles from preoperative to postoperative measurements were also significantly larger in the observation group than in the control group (P < 0.05). Radiographic parameters showed that postoperative TAS, TC, and TLS were significantly higher in the observation group than in the control group, while TT was significantly lower (P < 0.05). The pre-to-postoperative changes in TAS, TT, TC, and TLS were all greater in the observation group compared with the control group (P < 0.05). AOFAS scores and Barthel Index (BI), were significantly higher postoperatively in the observation group than in the control group (P < 0.05). The improvements from preoperative to postoperative scores were also greater in the observation group (P < 0.05). The incidence of postoperative complications was lower in the observation group compared with the control group (P < 0.05).Conclusion In the treatment of ankle fractures combined with distal tibiofibular syndesmosis injury, Endobutton loop plate elastic fixation demonstrates superiority over syndesmotic screw fixation in promoting early rehabilitation, enhancing ankle functional recovery, and minimizing the risk of complications.