Placement of distal tibiofibular screw by being parallel to tibial in treating ankle fracture with tibiofibular syndesmosis separation
10.3760/cma.j.issn.0253-2352.2018.21.002
- VernacularTitle:胫骨平行定位法置入下胫腓螺钉治疗下胫腓联合分离的踝关节骨折
- Author:
Changqing HU
1
;
Yong LIAN
;
Xiao FAN
;
Zhiping SUN
Author Information
1. 071000,河北省保定市第一中心医院骨科
- Keywords:
Ankle joint;
Fractures,bone;
Ligaments;
Wounds and injuries
- From:
Chinese Journal of Orthopaedics
2018;38(21):1293-1300
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical effect of placement of distal tibiofibular screw which is parallel to tibial in treating ankle fracture with tibiofibular syndesmosis separation.Methods Data of 59 cases with ankle fracture combined with tibiofibular syndesmosis separation from May 2014 to December 2015 were retrospectively analyzed.According to the direction of distal tibiofibular syndesmosis screw,59 cases were divided into two groups.There were 27 cases (18 males and 9 females) in Group A (parallel nailing group),with an average age of 42.00± 11.35 years.According to Lauge-Hansen classification,6 cases were supination extension-rotation Ⅲ and 9 were supination extension-rotation Ⅳ°,3 pronation extension-rotation Ⅲ and 7 pronation extension-rotation Ⅳ,2 pronation abduction ⅢL In group B (traditional nailing group),there were 32 cases (20 males and 12 females),with an average age of 44.00±13.34 years.According to Lauge-Hansen classification,5 cases were supination extension-rotation Ⅲ° and 12 supination extension-rotation Ⅳ°,4 pronation extension-rotation Ⅲ° and 8 pronation extension-rotation Ⅳ°,3 pronation abduction Ⅲ°.Two groups were compared of the flexion and extension angle of ankle joint after operation and function of ankle joint according to Baird-Jackson score.Results All the patients were followed up for 18 months.The fracture healing time of parallel nailing group was 2.5 to 5 months with an average of 3.4 months.While the fracture healing time of traditional nailing group was 2.5 to 6 months with the average of 3.8 months.The excellent rate of planting nail for group A was 100％ (24 cases for excellent and 3 for good),and for group B was 53.13％ (5 cases for excellent and 12 for good).There was significant difference between two groups (x2=16.97,P=0.0001).The excellent rate of group A was better than that in group B.6 weeks after operation,the flexion and extension angle of ankle joint was 25.00°±6.33° in group A and 17.00°±4.46° in group B with significant difference between two groups (t=5.82,P=0.0002).12 weeks after operation,the flexion and extension angle of ankle joint was 31.00°±7.75° in group A and 19.00°±5.58° in group B,with significant difference between two groups (t=7.54,P=0.0008).The flexion and extension angle of group A was better than that in group B for early postoperative period.6 months after operation,according to BairdJackson score,the excellent rate of ankle function of group A was 44.44％ (2 cases for excellent and 10 for good),and group B was 12.50％ (4 cases for good),with significant difference between two groups (x2=7.56,P=0.007).12 months after operation,the excellent rate of group A was 77.78％ (6 cases for excellent and 15 for good),group B was 34.38％ (2 cases for excellent and 9 for good),with significant difference between two groups (x2=11.11,P=0.001).18 months after operation,the excellent rate of ankle function of group A was 88.89％ (17 cases for excellent and 7 for good),and group B was 78.13％ (10 cases for excellent and 15 for good),with no significant differences (x2=0.56,P=0.23).One year after operation,the ankle function of group A was better than that in group B,while 18 months after operation,there was no statistical differences between the two groups.The data of 18 months after operation were further studied,using the method of stratified analysis,and the rate of excellent of group A was 59.26％ (16/27),while group B was 34.38％ (11/32),with significant difference between two groups (x2=3.65,P=0.049).The ankle function of group A was better than that of group B 18 months after operation.Conclusion Compared with the traditional method,this kind of method could accurately locate the distal tibiofibular syndesmosis screw.About early and mid-term postoperative period,it is superior to the traditional method for ankle function.
