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Title: [TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS].
Author: Wu B, Ding Z, Huang G, Liu G, Cai Z, Ding L, Li X.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2016 Sep 08; 30(9):1081-1084. PubMed ID: 29786359.
Abstract:
OBJECTIVE: To evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. METHODS: Between April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P>0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. RESULTS: All incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P>0.05). CONCLUSIONS: If the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis. 目的: 探讨采用下胫腓螺钉固定或不固定治疗Lauge-Hansen旋前-外旋型踝关节骨折合并的下胫腓联合分离疗效差异。. 方法: 2011年4月－2014年10月，收治46例旋前-外旋型踝关节骨折伴下胫腓联合分离患者，其中24例行下胫腓螺钉固定（固定组），22例未予下胫腓螺钉固定（未固定组）。两组患者性别、年龄、体质量、致伤原因、受伤至手术时间、侧别及骨折分型等一般资料比较，差异均无统计学意义（P＞0.05），具有可比性。记录两组术后完全负重时间、骨折愈合时间以及并发症发生情况。摄踝关节正侧位X线片，测量下胫腓重叠距离（tibiofibular overlap，TBOL）、下胫腓间隙（tibiofibular clear space，TBCS）；采用Baird-Jackson踝关节功能评分评价功能恢复情况。. 结果: 术后患者切口均Ⅰ期愈合，无手术相关并发症发生。两组患者均获随访，随访时间13~18个月，平均15.2个月。固定组完全负重时间为8~12周，中位时间11周；较未固定组的6~10周（中位时间8周）延长，比较差异有统计学意义（Z=—5.049，P=0.000）。X线片复查示两组患者下胫腓联合均获复位，骨折均愈合，固定组骨折愈合时间为（13.83±1.37）周、未固定组为（13.91±1.31）周，两组比较差异无统计学意义（t=—0.191，P=0.945）；无下胫腓联合分离复发、骨折延迟愈合、骨不连、内固定物松动及断裂等发生。术后即刻及末次随访时两组TBOL、TBCS比较，以及术后1年时两组Baird-Jackson踝关节功能评分及优良率比较，差异均无统计学意义（P＞0.05）。. 结论: Lauge-Hansen旋前-外旋型踝关节骨折合并下胫腓分离时（除Maisonneuve骨折），如能按损伤情况修复内、外及后踝结构，下胫腓螺钉固定与否对踝关节功能及影像学表现无明显影响。.

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