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。%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.
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