螺钉固定联合富血小板血浆注射治疗下胫腓损伤△

Syndesmotic screw combined with platelet rich plasma for distal tibiofibular syndesmosis injury

摘要:

［目的］ 探讨螺钉固定结合富血小板血浆治疗下胫腓联合损伤的临床效果。［方法］ 2018 年 6 月—2019 年 7 月 96 例踝部骨折下胫腓联合损伤患者纳入本研究，根据医患沟通结果将患者分为两组，其中，48 例采用下胫腓螺钉固定联合局部 PRP 注射，另外 48 例仅行下胫腓螺钉固定。比较两组围手术期、随访及影像资料。［结果］两组患者均顺利完成手术，术中无严重并发症。两组患者手术时间、切口长度和术前 VAS 评分的差异均无统计学意义（P>0.05）；但 PRP 组术中失血量、术后引流量、术后 3 d 肿胀评级、术后 3 d 瘀斑评级、切口愈合、术后 24 h 至出院时 VAS 评分、下地行走时间和住院天数均显著优于非 PRP 组 （P<0.05）。随访 12 个月以上，PRP 组恢复完全负重活动时间显著早于非 PRP 组 （P<0.05）。与术后 3 个月相比较， 末次随访时两组活动时 VAS 评分均显著下降 （P<0.05），而 AOFAS 评分和 ROM 均显著增加 （P<0.05）。术后相应时间点 PRP 组的 VAS、AOFAS 评分，以及 ROM 均显著优于非 PRP 组（P<0.05）。影像方面，与术前相比，末次随访时两组的 TCS 和 MCS 均显著减少 （P<0.05），而 TFO 显著增加 （P<0.05）。末次随访时 PRP 组的上述影像指标均显著优于非 PRP 组 （P<0.05）。［结论］螺钉固定联合 PRP 治疗下胫腓联合损伤可减轻术后早期损伤反应，加速韧带愈合，有利于功能恢复。

Abstract:

[Objective] To investigate the clinical outcomes of syndesmotic screw combined with platelet rich plasma (PRP) for treat- ment of distal tibiofibular syndesmosis injury. [Methods] From June 2018 to July 2019, a total of 96 patients with ankle fracture and distal tibiofibular syndesmosis injury were enrolled in this study, and were divided into two groups by random number table method. Of them, 48 patients received tibiofibular screw fixation combined with local PRP injection (the PRP group) , while the other 48 patients received tibio- fibular screw fixation only (the non-PRP group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation done successfully without serious complications. Although there were no significant dif- ferences in operative time, incision length and preoperative VAS score between 2 groups (P＞0.05) , the PRP group proved significantly su- perior to the non-PRP group in terms of intraoperative blood loss, postoperative drainage volume, swelling and petechial grades 3 days post- operatively, as well as incision healing, VAS score from 24 hours postoperatively to discharge, time to return walking postoperatively and hospital stay (P＜0.05) . The follow up period lasted for more than 12 months. The PRP group resumed full weight-bearing activity signifi- cantly earlier than the non-PRP group (P＜0.05) . The VAS scores significantly decreased (P＜0.05) , whereas the AOFAS score and plantar flexion-dorsal extension range of motion (ROM) significantly increased in both groups at the latest follow up compared to those preopera- tively (P＜0.05) . The PRP group was significantly superior to the non-PRP group in aforesaid items at the latest follow up (P＜0.05) . Radio- graphically, the tibiofibular clear space (TFCS) and medial clear space (MCS) significantly reduced (P＜0.05) , while the tibiofibular overlap (TFO) increased significantly in both groups at the latest follow-up compared with those preoperatively (P＜0.05) , which in PRP group were significantly better than those in non-PRP group at the latest follow up (P＜0.05) . [Conclusion] Tibiofibular screw fixation combined with PRP for distal tibiofibular syndesmosis injury does alleviate early postoperative injury reaction, accelerate ligament healing, and benefit functional recovery.