CAJ | 학술논문

目的通过前瞻性随机对照研究评估金属(钛合金)和生物可吸收(多聚左旋乳酸)螺钉固定下胫腓联合的疗效,并分析潜在的并发症风险.方法 2007年1月- 2008年5月共48例踝关节骨折伴下胫腓联合损伤患者入组.通过随机数字表法实现完全随机分组,其中金属螺钉固定组20例,可吸收螺钉固定组28例.47例患者接受至少2年的随访,进行影像学和临床评估.结果总随访率达98％.两组患者人口学信息差异无统计学意义(P＞0.05).随访满1年及2年时,两组间Baird评分各指标、总分及Baird评级差异均无统计学意义(P＞0.05).至随访末,两组患、健侧踝关节之间活动度差异有统计学意义(P＜0.05).可吸收螺钉组主要出现2例中度排异反应及2例下胫腓异位骨化并发症.结论可吸收螺钉是下胫腓联合损伤固定的有效内置物,与金属材料螺钉相比,可避免二次手术取出,同时可以达到与前者相同的固定效果.但其也存在多种并发症的可能,如排异反应及异位骨化等不容忽视.
목적 통과전첨성수궤대조연구평고금속(태합금)화생물가흡수(다취좌선유산)라정고정하경비연합적료효,병분석잠재적병발증풍험.방법 2007년1월- 2008년5월공48례과관절골절반하경비연합손상환자입조.통과수궤수자표법실현완전수궤분조,기중금속라정고정조20례,가흡수라정고정조28례.47례환자접수지소2년적수방,진행영상학화림상평고.결과 총수방솔체98％.량조환자인구학신식차이무통계학의의(P＞0.05).수방만1년급2년시,량조간Baird평분각지표、총분급Baird평급차이균무통계학의의(P＞0.05).지수방말,량조환、건측과관절지간활동도차이유통계학의의(P＜0.05).가흡수라정조주요출현2례중도배이반응급2례하경비이위골화병발증.결론 가흡수라정시하경비연합손상고정적유효내치물,여금속재료라정상비,가피면이차수술취출,동시가이체도여전자상동적고정효과.단기야존재다충병발증적가능,여배이반응급이위골화등불용홀시.
Objective To evaluate the effect and potential risks of two types of materials ( taitanum versus polylevolactic acid,PLLA) screws on fixation of distal tibiofibular syndesmosis by a prospective randomized comparative clinical study.Methods From January 2007 to May 2008,48 patients with ankle fractures combined with a verified syndesmotic rupture were randomly allocated to receive either bioabsorbable PLLA (n =28 ) or titanium (n =20) screw fixation.The patients were assessed in aspects of radiography,function recovery and complication during follow-up.Results The total followup rate was 98％.The demographic information of the two groups showed no statistical difference ( P ＞0.05).After 1-2 years of follow-up,the indexes including Baird score,total score,and Baird grade were not statistically different between the two groups ( P ＞ 0.05).At the end of follow-up,there was significant difference in regard of joint motion between the injured and uninjured ankle in both groups ( P ＜0.05).Moderate rejection occurred in two patients and tibiofibular heterotopic ossification in two in PLLA group.Conclusions There is no significant difference between the bioabsorbable and metallic screws with regard to ankle function recovery,but the bioabsorbable screw fixation can avoid a second operation for taking out the screw.However,the complication risk of the bioabsorbable screws should not be ignored,such as rejection reaction,heterotopic ossification.