文献类型：期刊文献

中文题名：TightRope与螺钉固定治疗下胫腓联合损伤的比较

英文题名：TightRope fixation versus tricortical screw fixation for inferior tibiofibular syndesmosis injury

作者：杨学锋[1];赵继荣[2];许宏斌[1];黄凯[1];魏博[1];强胜林[1]

第一作者：杨学锋

机构：[1]甘肃中医药大学附属医院创伤骨科,甘肃兰州730020;[2]甘肃中医药大学中医临床学院,甘肃兰州730101

第一机构：甘肃中医药大学第二附属医院

年份：2025

卷号：33

期号：15

起止页码：1365

中文期刊名：中国矫形外科杂志

外文期刊名：Orthopedic Journal of China

收录：;北大核心:【北大核心2023】；

基金：甘肃省自然科学基金项目(编号:22JR5RA612);甘肃省卫生计生委管理项目(编号:GSWSKY2023-52)。

语种：中文

中文关键词：下胫腓联合损伤;TightRope;螺钉;下胫腓联合固定

外文关键词：inferior tibiofibular syndesmosis injury;TightRope;screws;distal tibiofibular syndesmosis fixation

摘要：[目的]比较TightRope与螺钉固定治疗胫腓联合损伤的临床疗效。[方法]回顾性分析2019年1月-2023年1月180例下胫腓联合损伤患者的临床资料,根据患者意愿,90例采用TightRope固定(扣板组),90例采用螺钉固定(螺钉组)。比较两组围手术期资料、随访以及影像结果。[结果]两组手术时间、术中出血量、切口长度、下地行走时间、切口愈合时间、住院时间、并发症发生率差异无统计学意义(P>0.05);扣板组完全负重时间显著早于螺钉组[(10.4±2.4)周vs(12.0±2.6)周, P<0.001]。随着时间的推移,美国足踝外科协会(American Orthopedic Foot and Ankle Society, AOFAS)评分、跖屈-背伸活动度(range of motion, ROM)均显著升高(P<0.05),而疼痛视觉模拟评分(visual analogues scale, VAS)逐渐降低(P<0.05);术后1个月扣板组的AOFAS评分[(70.8±6.6)分vs(65.8±5.9)分, P<0.001]和跖屈-背伸ROM[(24.7±3.8)°vs(18.7±3.4)°, P<0.001]均显著优于螺钉组。影像方面,与术前相比,术后两组胫腓净间隙(tibiofibular clear space, TFCS)均显著降低(P<0.05),而胫腓骨重叠(tibiofibular overlap, TFO)显著增加(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。此外,两组螺钉断裂、下胫腓联合再分离发生率的差异无统计学意义(P>0.05)。[结论] TightRope纽扣钢板固定下胫腓联合损伤能获得与螺钉固定一致的固定效果,但扣板固定可更早负重,有利于功能恢复。
[Objective]To compare the clinical efficacy of TightRope fixation versus tricortical screw fixation in the treatment of distal tibiofibular syndesmosis injury.[Methods]A retrospective study was conducted on 180 patients who had interior tibiofibular syndesmosis tear treated surgically from January 2019 to January 2023.According to the patients'selection,90 of them had the syndesmosis tear fixed by TightRope,while other 90 were fixed by tricortical screws.The documents regarding to perioperative period,followup and imaging were compared between the two groups.[Results]There were no significant differences in operation time,intraoperative blood loss,incision length,walking time,incision healing time,hospital stay and complication rate between the two groups(P>0.05).However,the TightRope group resumed full weight-bearing activity significantly earlier than the screw group[(10.4±2.4)weeks vs(12.0±2.6)weeks,P<0.001].The American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot score and plantar flexion-dorsal extension range of motion(ROM)were significantly increased(P<0.05),whereas the visual analogues scale(VAS)for pain were significantly decreased over time in both groups(P<0.05).The TightRope group proved significantly superior to the screw group in terms of AOFAS score[(70.8±6.6)vs(65.8±5.9),P<0.001]and plantar flexion-dorsal-extension ROM[(24.7±3.8)°vs(18.7±3.4)°,P<0.001]one month after surgery.As for imaging,the tibiofib-ular clear space(TFCS)decreased significantly(P<0.05),while tibiofibular overlap(TFO)increased significantly in both groups postoperatively compared with those preoperatively(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).In addition,there was no significant difference in the incidence of implant failure and distal tibiofibular syndesmosis re-separation between the two groups(P>0.05).[Conclusion]The TightRope can achieve the same consequence as screw fixation in fixing distal tibiofibular syndesmosis injury,but the TightRope is beneficial to functional recovery,including earlier restoration of full weight bearing activity.