| Objective:In this study,we investigated the clinical efficacy of one-stage ligament repair and inferior tibiofibular screw fixation in patients with Lauge-Hansen classification of grade IV supination and external rotation ankle fracture with inferior tibiofibular syndesmosis injury.Methods:In this study,a clinical randomized controlled trial was used to analyze 53 patients with Ser-IV ° ankle fracture associated with DTS injury in the Department of Traumatic Orthopedics of Qinghai Univeristy Affiliated Hospital from November 2019 to September 2020.The 25 patients in the primary ligament repair group(group A)were treated by ORIF for anatomical reduction and fixation of the broken end of the fracture.For the broken or avulsion fractures of the medial DL,AITFL and PITFL caused by high energy injury,they were fixed with sutures or rivets with sutures,without the need to place inferior tibifibular screws.In the inferior tibiofibular screw fixation group(group B),1 or 2 3.5mm inferior tibiofibular screws penetrating 3 cortices were placed at a certain position and Angle after anatomic reduction and fixation of the broken end of the fracture by ORIF.The duration of operation and intraoperative blood loss were compared between the two groups.TFCS and TFO during postoperative follow-up were recorded and measured.The excellent rate of postoperative ankle joint was compared,and the treatment effect was evaluated using AOFAS scoring scale.Results:1.The general information of the two groups: gender,age,injury to operation time,etc.,were compared by using professional statistical methods,and the data of the two groups were balanced and comparable.2.Two sets of data in the operation time in group A(69.0±11.8)min and group B(71.2±13.3)min,intraoperative blood loss of group A(56.4±17.2)ml and group B(63.9±17.5)ml,and postoperative follow-up of 6 months after 3 days TFCS,TFO,postoperative 3 months and 6 months postoperative AOFAS ankle function score,and the rate of good the last AOFAS comparison difference had no statistical significance(P>0.05).3.Postoperative complications and VAS score: 1 patient in group A had incision infection,2 patients in group B had joint instability,1 patient had screw fracture,and VAS score at the last follow-up;(0.76±0.59)in group A and(1.04±0.83)in group B,and there was no statistical significance between the two groups(P>0.05).Conclusions:1.In patients with Ser-IV ° ankle fractures with DTS injuries,after the reduction and fixation of the broken end,the repair of the ligaments associated with the injury,such as DL,AITFL,and PITFL on the medial side of the ankle,after 4-6 weeks of plaster external fixation,can result in ligamentous scar repair,with a post-operative strength and functional stability comparable to that of the inferior tibifibular screw fixation group.2.There were no differences in TFCS and TFO between the two groups,as well as in AOFAS functional score and VAS pain visual analogue scale.However,the cost,risk and complications of the second operation were avoided in the treatment of the inferior tibiofibular injury in the ligament repair group. |
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