CAJ | 학술논문

目的：评估踝关节骨折内固定方法和其他危险因素与术后胫腓骨远端骨性连接发生的关系。方法收集踝关节骨折术后患者资料，评估是否存在下胫腓骨性连接。所有骨折都使用钢板治疗，有需要者辅以下胫腓螺钉。记录和分析患者病史、损伤情况以及内固定方法。同时对并发症进行回顾性分析，功能评分采用FAOS（Foot and Ankle Outcome Score）评分。结果286例踝关节骨折纳入本研究，39例发生完全连接，20例发生不完全骨性桥接。多变量分析显示男性（OR＝2．54，P＜0．01），下胫腓螺钉置入（OR＝2．02，P＜0．01）和胫距脱位（OR＝1．61，P＝0．041）是独立的危险因素。伴有骨性连接的踝关节背伸（P＝0．009）、跖屈（P＝0．013）和内翻（ P＜0．001）活动受限，但是随访其功能和非连接者一致。结论下胫腓螺钉、男性和胫距关节脱位是术后胫腓骨远端骨性连接的显著性危险因素，骨性连接会导致踝关节活动受限，但对其功能无显著性影响。
목적：평고과관절골절내고정방법화기타위험인소여술후경비골원단골성련접발생적관계。방법수집과관절골절술후환자자료，평고시부존재하경비골성련접。소유골절도사용강판치료，유수요자보이하경비라정。기록화분석환자병사、손상정황이급내고정방법。동시대병발증진행회고성분석，공능평분채용FAOS（Foot and Ankle Outcome Score）평분。결과286례과관절골절납입본연구，39례발생완전련접，20례발생불완전골성교접。다변량분석현시남성（OR＝2．54，P＜0．01），하경비라정치입（OR＝2．02，P＜0．01）화경거탈위（OR＝1．61，P＝0．041）시독립적위험인소。반유골성련접적과관절배신（P＝0．009）、척굴（P＝0．013）화내번（ P＜0．001）활동수한，단시수방기공능화비련접자일치。결론하경비라정、남성화경거관절탈위시술후경비골원단골성련접적현저성위험인소，골성련접회도치과관절활동수한，단대기공능무현저성영향。
Objective To evaluate the relationship between ankle fracture fixation method and other risk factors in the development of synostosis in posttraumatic operative ankle fractures.Methods All operative ankle fractures were evaluated for the presence of distal tibiofibu-lar synostosis.All fractures were treated in a fracture-specific and ligament-specific fashion with syndesmotic screws if needed.Patient de-mographic and medical history data as well as injury and fixation profile were evaluated.Incidence of complications was also reviewed.Ameri-can orthopaedic foot and ankle society( FAOS) score were compared between the groups.Results Of the 286 ankle fractures included in the study, 39 demonstrated complete synostosis and 20 demonstrated incomplete bony bridging.Multivariate analysis revealed male sex(OR=2.54, P<0.01), syndesmotic screw fixation((OR=2.02, P<0.01), and tibiotalar dislocation(OR=1.61, P=0.041) to remain significant inde-pendent risk factors for the development of incomplete bony bridging or complete synostosis while adjusting for confounding risk factors.Ankles with synostosis also demonstrated significant reduction in dorsiflexion ( P=0.009 ) , plantarflexion ( P=0.013 ) , and inversion ( P<0.001 ) , though follow-up outcome measures were equivalent with patients without synostosis.Conclusion Syndesmotic screw fixation, male sex, and tibiotalar dislocation were significant risk factors in the formation of postoperative distal tibiofibular synostosis.Bony synostosis reduces ankle joint mobility, but there is no significant impact on its function.