Clinical Observation Of The Anterior Tibiofibular Syndesmosis Repaired With Cortical Bone Anchor

ObjectiveTo compare the early clinical effect of cortical bone anchor fixation and screw fixation,in order to provide a new treatment method and idea for the clinical treatment of the fresh distal tibiofibular syndesmosis injury complicated by ankle joint fracture.MethodsThe retrospective included 44 cases of hospitalization in department of orthopedics,the first affiliated hospital of guangzhou university of traditional Chinese medicine,from June 1,2014 to June 1,2017.All patients had ankle joint fracture with anterior tibiofibular syndesmosis injury.24 patients who received screw fixation were included in the screw group.20 patients receiving the treatment of cortical bone anchor fixation were included in the anchor group.The gender,age,injury side,Danis-Weber classification and operation time were recorded in all patients.Radiographs were evaluated before and after surgery.Radiographic evaluation of the preoperative and postoperative X-ray of patients.To measure and compare the tibiofibular clear space?tibiofibular overlap?medial clear space and superior clear space in the two groups.The ratio of MCS/SCS was calculated and compared.The functional score of the ankle joint was evaluated by using the AOFAS Ankle Hindfoot Scale to assess the functional recovery of the ankle joint.Results1.Operation time comparison:The average operation time of the screw group was 119.17±34.28 minutes,and the average operation time of the anchor group was 113.55±42.77 minutes.The average operation time of the anchor nail group was slightly shorter than that of the screw group,but there was no statistically significant difference(P>0.05).2.The tibiofibular clear space comparison:Postoperative TFCS of the screw group average was 4.46±1.57 mm,and postoperative TFCS of the anchor group average was 4.27±0.89 mm.The difference was not statistically significant(P>0.05),and the difference between the two groups was statistically significant(P<0.01).Compared with preoperative and postoperative TFCS of two groups,the difference was statistically significant(P<0.01).3.The tibiofibular overlap comparison:Postoperative TFO of the screw group average was 6.96±2.45 mm,and postoperative TFO of the anchor group average was 6.89±1.84 mm.There was no statistically significant difference between the two groups(P>0.05),Compared with preoperative and postoperative TFO of two groups,the difference was statistically significant(P<0.01).4.The medial clear space comparison:Postoperative MCS of the screw group average was 3.80±1.02 mm,and postoperative MCS of the anchor group average was 3.82±0.69 mm.There was no statistically significant difference between the two groups(P>0.05),Compared with preoperative and postoperative MCS of two groups,the difference was statistically significant(P<0.01).5.The superior clear space comparison:Postoperative SCS of the screw group average was 3.81±0.83 mm,and postoperative SCS of the anchor group average was 3.80±0.54 mm.There was no statistically significant difference between the two groups(P>0.05),Compared with preoperative and postoperative SCS of two groups,the difference was not statistically significant(P>0.05).6.The ratio of MCS/SCS comparison:Postoperative MCS/SCS of the screw group average was 1.05±0.41,and postoperative MCS/SCS of the anchor group average was 1.02±0.21.There was no statistically significant difference between the two groups(P>0.05),Compared with preoperative and postoperative MCS/SCS of two groups,the difference was statistically significant(P<0.01).7.The AOFAS Ankle Hindfoot Scale comparison:All patients were followed up,and follow-up time was 7 to 43 months.The AOFAS score averaged 84.38±6.79 in the final follow-up of the screw group,and the anchor group was 88.50±5.41.the difference between the two groups was statistically significant(P<0.05).ConclusionIt is easier to repair the anterior tibiofibular syndesmosis with cortical bone anchor.Cortical bone anchor fixation and screw fixation have the same effect on maintaining the dissection of the tibiofibular.They can all achievesimilar fixed efficiency.Patients who have received cortical bone anchor fixation can obtain the better ankle joint function.It can avoid the removal of screws by secondary operation.It can also avoid the complications such as screw extraction and screw loose.Worthy of clinical promotion.