生物可吸收固定
这种方法用于固定踝关节骨折时与金属钢板螺钉类似,但其材料为生物可吸收的。大量的证据证实骨折愈合后无需行内固定物取出术。[22]Petrisor BA, Poolman R, Koval K, et al. Management of displaced ankle fractures. J Orthop Trauma. 2006;20:515-518.http://www.ncbi.nlm.nih.gov/pubmed/16891946?tool=bestpractice.com研究发现在不良事件上并没有统计学差异,如异物反应、感染、骨关节炎、疼痛、再骨折、皮肤坏死、深静脉血栓和神经损伤等。生物可吸收固定可获得类似的功能结果。[34]Li ZH, Yu AX, Guo XP, et al. Absorbable implants versus metal implants for the treatment of ankle fractures: a meta-analysis. Exp Ther Med. 2013;5:1531-1537.http://www.ncbi.nlm.nih.gov/pubmed/23737914?tool=bestpractice.com[35]Hu YL, Yuan WQ, Wang LF, et al. A prospective randomized trial of poly-DL-lactic acid absorbable and metallic screws for treatment of syndesmotic disruptions [in Chinese]. Nan Fang Yi Ke Da Xue Xue Bao [J South Med Univ.]. 2010;30:2360-2362.http://www.ncbi.nlm.nih.gov/pubmed/20965846?tool=bestpractice.com
下胫腓纽扣缝合修复
对于急性下胫腓联合损伤,目前有新的纽扣缝合固定设备。与螺钉固定相比,结果类似,但很少需要取出内固定物。目前还没有长期随访的数据。[36]Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012;36:1199-1206.http://link.springer.com/article/10.1007/s00264-012-1500-2/fulltext.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/22318415?tool=bestpractice.com[37]Kortekangas T, Savola O, Flinkkilä T, et al. A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography. Injury. 2015;46:1119-1126.http://www.ncbi.nlm.nih.gov/pubmed/25769201?tool=bestpractice.com[38]Laflamme M, Belzile EL, Bédard L, et al. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015;29:216-223.http://www.ncbi.nlm.nih.gov/pubmed/25260059?tool=bestpractice.com