[摘要]目的探讨Knotless TightRope缝合器治疗陈旧性下胫腓联合损伤伴分离的临床疗效。方法连续52例陈旧性损伤患者接受手术，依次分为试验组和对照组，先进行满意复位。试验组使用Knotless TightRope下胫腓联合缝合器固定,对照组采用4.5mm螺钉固定。记录患者术后的VAS评分、AOFAS评分、SF-36评分和踝关节活动度，并记录术后伤口感染、内固定断裂及下胫腓联合再分离等并发症。结果 本组52例均获随访，平均随访时间22.3个月。踝关节活动度两组间无统计学差异；VAS评分、SF-36评分、AOFAS评分术后3月、6月无统计学差异；术后22月存在统计学差异。两组均无伤口感染，试验组无再次胫腓分离发生，对照组5例内固定断裂后发生胫腓再次分离，组间统计学差异存在显著性。 结论Knotless TightRope下胫腓联合缝合器治疗陈旧性下胫腓联合损伤伴下胫腓分离的中期疗效确切，具有固定效果可靠、 不存在内固定断裂、且患者可早期负重锻炼等优点。
[Abstract] ObjectiveTo investigate the clinical efficacy of suture-fixationfor the old injury of distal tibiofibular syndesmosis treated with Knotless TightRope.Methods52 consecutive patients undergoing surgery were divided into experimental and control groups.The experimental group was treated by Knotless TightRope, Control group was treated with 4.5mm screws. Postoperative complications, motion range of ankle-joint,VAS score, AOFAS score, SF-36 scores were recorded.Result Average follow-up period of 52 patients is 22.3 months. All scores have no significant difference after 6 months follow-up, but there is statistical difference in 22 months. All cases healed without infection. In experimental group,no re-seperation was observed.In control group,distal tibiofibular syndesmosis seperated in 5 patients after fixation breakage.ConclusionKnotless TightRopehas definite clinical effect to for the old injury of distal tibiofibularsyndesmosis.Reliable fixation has the advantages of early exercise with full weight bearing.
[1] Schepers T: Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop 2012, 36(6):1199-1206.
[2] Seitz WH, Jr., Bachner EJ, Abram LJ, Postak P, Polando G, Brooks DB, Greenwald AS: Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma 1991, 5(1):78-82.
[3] Thornes B, Walsh A, Hislop M, Murray P, O'Brien M: Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study. Foot Ankle Int 2003, 24(2):142-146.
[4] Seyhan M, Donmez F, Mahirogullari M, Cakmak S, Mutlu S, Guler O: Comparison of screw fixation with elastic fixation methods in the treatment of syndesmosis injuries in ankle fractures. Injury 2015, 46 Suppl 2:S19-23.
[5] Laflamme M, Belzile EL, Bedard L, van den Bekerom MP, Glazebrook M, Pelet S: A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma 2015, 29(5):216-223.
[6] Peterson KS, Chapman WD, Hyer CF, Berlet GC: Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair. Foot Ankle Int 2015, 36(6):679-684.
[7] Choi NH，Oh JS，Jung SH，et a1．Correlation between endobuttonloop length and tunnel widening after hamstring anterior crneiate ligament reconstruction．Am J Sprots Med，41(1):101-106．
[8] Kesemenli CC，Memisoglu K，Atmaca H．A minimally invasivetechnique for the reduction of calcaneal fractures using the endobutton．J Foot Ankle Surg，2013，52(2):215-220.
[9] Hong CC, Lee WT, Tan KJ: Osteomyelitis after TightRope((R)) fixation of the ankle syndesmosis: a case report and review of the literature. J Foot Ankle Surg 2015, 54(1):130-134.
