非刚性内固定治疗踝关节骨折合并下胫腓联合损伤患者术后踝关节功能和生活质量的影响

摘要 目的：探讨非刚性内固定治疗踝关节骨折合并下胫腓联合损伤的临床疗效及对术后踝关节功能和生活质量的影响。方法：回顾性分析2015年1月至2020年6月我院收治的60例踝关节骨折合并下胫腓联合损伤患者的诊治资料。根据内固定方法的不同，将患者分为非刚性组（n=30，采用非刚性内固定治疗下胫腓联合损伤）和传统螺钉组（n=30，采用传统螺钉内固定治疗下胫腓联合损伤）。比较两组的围术期指标和完全负重所需时间、手术前后的下胫腓重叠距离（TBOL）和下胫腓间隙（TBCS）；以美国足踝外科协会（AOFAS）踝-后足评分评估两组的术后踝关节功能，以世界卫生组织生活质量测定简表（WHOQOL-BREF）评估两组的生活质量，并比较两组的术后并发症情况。结果：非刚性组的完全负重所需时间短于传统螺钉组，操作角度大于传统螺钉组（均P<0.05）。两组患者术后6周、12周和6个月的TBOL均大于术前，TBCS均小于术前（均P<0.05），但两组术后6周、12周和6个月的TBOL和TBCS相比无明显差异（P>0.05）。非刚性组术后12周的AOFAS评分高于传统螺钉组（P<0.05）；两组术后6个月的AOFAS评分均较术后12周升高（P<0.05），但组间比较无明显差异（P>0.05）。术后6个月，非刚性组的WHOQOL-BREF各项评分及总分均高于传统螺钉组（P<0.05）。两组并发症发生率比较无明显差异（P>0.05）。结论：非刚性与传统螺钉内固定治疗踝关节骨折合并下胫腓联合损伤的临床疗效及康复效果相当，但非刚性固定的操作更加便利，术后恢复较快，患者术后生活质量更高，可较早完全负重。

Effect of Non Rigid Internal Fixation on Ankle Function and Quality of Life after Operation in Patients with Ankle Fracture Combined with Lower Tibiofibular Syndesmosis Injury

ABSTRACT Objective: To investigate the clinical effect of non rigid internal fixation in the treatment of ankle fracture combined with lower tibiofibular syndesmosis injury and its influence on ankle function and quality of life after operation. Methods: The diagnosis and treatment data of 60 patients with ankle fracture combined with lower tibiofibular syndesmosis injury who were treated in our hospital from January 2015 to June 2020 were retrospectively analyzed. According to the different methods of internal fixation, the patients were divided into non-rigid group(n=30, using non-rigid internal fixation treat the lower tibiofibular syndesmosis injury) and traditional screw group(n=30, using traditional screw internal fixation treat the lower tibiofibular syndesmosis injury). The perioperative indexes and the time required for full weight bearing, the distances between the tibiofibular overlap(TBOL) and the tibiofibular space (TBCS) before and after operation were compared between the two groups. The ankle-hind foot score of the American Association of Foot and Ankle Surgery(AOFAS) was used to evaluate the ankle function of the two groups, the quality of life of the two groups was evaluated by WHOOQOL-BREF, and the postoperative complications of the two groups were compared. Results: The operating angle of the non-rigid group was larger than that of the traditional screw group, and the time required for full weight bearing was shorter than that of the traditional screw group, and the differences were statistically significant (all P<0.05). TBOL at 6 weeks, 12 weeks and 6 months after operation in both groups were greater than those before operation, and TBCS was smaller than that before operation, the difference was statistically significant(all P<0.05). There were no significant differences in TBOL and TBCS between the two groups at 6 weeks, 12 weeks and 6 months after operation, there were no significant differences(P>0.05). 12 weeks after operation, the AOFAS score of the non-rigid group was higher than that of the traditional screw group(P<0.05). 6 months after operation, the AOFAS scores of both groups were higher than those of 12 weeks after operation(P<0.05), however, there was no significant difference between the two groups(P>0.05). 6 months after operation, the WHOQOL-BREF scores of the non rigid group were higher than those of the traditional screw group, and the difference was statistically significant(P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion: The long-term curative effect and rehabilitation effect of non-rigid and traditional screw internal fixation in the treatment of ankle fracture combined with lower tibiofibular syndesmosis injury are similar, but the operation of non-rigid fixation is more convenient, the recovery is faster, the postoperative quality of life was high, and the weight-bearing can be completed earlier.