术后不同时间取出下胫腓螺钉对肥胖患者踝关节功能的影响OA

Objective To determine whether the removal of distal tibiofibular screws at different time points after surgery affects the ankle joint function in obese patients with ankle fractures combined with distal tibiofibular syndesmosis injuries.Methods The clinical data of obese patients with ankle fractures combined with distal tibiofibular syndesmosis injuries admitted to General Hospital of Northern Theater Command from July 2014 to July 2023 were retrospectively analyzed.According to the inclusion and exclusion criteria,57 patients were finally included and divided into the early group(screw removal at 8-10 weeks postoperatively,27 cases)and the delayed group(screw removal at 14-16 weeks postoperatively,30 cases)based on the different time points of screw removal.The perioperative complications and bone healing time of the two groups were recorded.At the 1-year follow-up,the American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score,visual analogue scale(VAS)score,and ankle joint range of motion were compared between the two groups.Results All patients completed the 1-year follow-up.During screw removal,there was 1 case of screw breakage in the early group and 5 cases in the delayed group,with a statistically significant difference(3.7％vs 16.7％,P<0.05).No incision complications occurred after screw removal in either group.There was no statistically significant difference in bone healing time between the two groups(P>0.05).At the 1-year follow-up,the range of motion of the affected ankle joint in the early group was less than that of the healthy side in plantar flexion[(25.3±6.1)° vs(38.6±4.8)°,t=3.211,P=0.003]and inversion[(15.4±3.2)° vs(25.6±4.3)°,t=4.374,P<0.001].In the delayed group,the range of motion of the affected ankle joint was less than that of the healthy side in plantar flexion[(26.1±4.4)° vs(36.9±6.1)°,t=3.713,P<0.001)],dorsiflexion[(20.7±4.1)° vs(22.5±5.3)°,t=2.094,P=0.047]and inversion[(14.8±4.2)° vs(26.3±3.9)°,t=2.414,P=0.022].However,there were no statistically significant differences in the AOFAS score and VAS score,between the two groups(P>0.05).Conclusion For obese patients with ankle fractures combined with distal tibiofibular syndesmosis injuries,the range of motion of the ankle joint is reduced compared with that before surgery at both groups.There was no statistically significant difference in the influence on ankle joint function among patients with different distal tibiofibular screw removal times,but early removal can reduce the risk of screw breakage and facilitate early rehabilitation of the patient.