可吸收与金属螺钉固定Maisonneuve骨折比较△（开放获取）

Absorbable versus metal screws for internal fixation of Maisonneuve's fractures

摘要:

[目的] 比较可吸收与金属螺钉内固定治疗Maisonneuve 骨折的临床疗效。[方法] 回顾性分析本科2020 年1 月—2021 年10 月收治31 例Maisonneuve 骨折患者的资料，均行骨折切开复位内固定术，其中15 例采用可吸收螺钉进行固定，16例采用金属螺钉固定。比较两组围手术期、临床及影像结果。[结果] 两组患者在手术时间、切口总长度、术中失血量、术中透视次数、切口愈合、住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（19.2±4.6） 个月。可吸收钉组术后恢复完全负重活动时间显著早于金属钉组[(70.4±8.6) d vs (84.6±5.6) d, P＜0.001]。随术后时间推移，两组的AOFAS 评分、踝背伸-跖屈ROM 均显著增加，而VAS 评分显著减小（P＜0.05）。术后3 个月，可吸收钉组的踝背伸-跖屈ROM 显著大于金属钉组[(42.5±3.6)° vs (38.2±4.9)°, P=0.009]，但术后12 个月和末次随访时两组差异已无统计学意义（P＞0.05）。相同时间点，两组的AOFAS评分、VAS 评分的差异均无统计学意义（P＞0.05）。影像方面，两组术后骨折复位质量的差异无统计学意义（P＞0.05）。与术前相比，末次随访时两组的MCS、TFCS 均显著减少（P＜0.05），而TFO 显著增加。在相同的时间点，两组间MCS、TFCS、TFO的差异均无统计学意义（P＞0.05）。至末次随访时，两组患者骨折均愈合，愈合时间差异无统计学意义（P＞0.05）。[结论] 可吸收螺钉固定治疗Maisonneuve 骨折的疗效与金属螺钉相似，可早期负重锻炼，无需二次手术取出。

Abstract:

[Objective] To compare the clinical efficacy of absorbable versus metal screws for internal fixation of Maisonneuve frac-tures. [Methods] A retrospective study was conducted on 31 patients who received surgical treatment for Maisonneuve fractures in our de-partment from January 2020 to October 2021. Based on preoperative surgeon-patient discussion, 15 patients had internal fixation with ab-sorbable screws, while the remaining 16 patients were with metal screws. The perioperative, clinical and imaging documents were comparedbetween the two groups. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, in-traoperative fluoroscopy times, incision healing grade and hospital stay between the two groups (P＞0.05). All patients in both groups werefollowed up for a mean of (19.2±4.6) months, and the absorbable group resumed full weight-bearing activity significantly earlier than themetal group [(70.4±8.6) days vs (84.6±5.6) days, P＜0.001]. As time went by, the AOFAS score and ankle dorsal-plantar flexion ROM inboth groups increased significantly, while the VAS score decreased significantly (P＜0.05). At 3 months after surgery, the absorbable groupproved significantly superior to the metal group regarding ankle dorsal-plantar flexion ROM [(42.5±3.6)° vs (38.2±4.9)°, P=0.009], whereaswhich turned to be no significant difference between the two groups at 12 months after surgery and the last follow-up (P＞0.05). In addition,there were no statistically significant differences in terms of AOFAS and VAS scores between the two groups at any time points accordingly(P＞0.05). With respect to imaging, there was no statistically significant difference in postoperative fracture reduction quality between thetwo groups (P＞0.05). Compared with those preoperatively, the medial clear space (MCS) and tibiofibular clear space (TFCS) in both groupssignificantly declined (P＜0.05), while the tibiofibular overlap (TFO) increased significantly at the last follow-up (P＜0.05), which proved notstatistically significant between the two groups at any matching time points (P＞0.05). At the last follow-up, all patients in both group got theinjury healed well with on a statistically significant difference in healing time between them (P＞0.05). [Conclusion] The absorbable screwfixation does achieve similar clinical consequence with the metal counterpart for Maisonneuve fracture, however, the former has advantages of early weight-bearing exercise and no need for secondary surgery to remove the implant over the latter.