手术治疗踝关节骨折伴三角韧带损伤的疗效观察  

EFFECTIVENESS OF SURGERY IN TREATMENT OF ANKLE FRACTURES ASSOCIATED WITH DELTOID LIGAMENT INJURY

作　　者：王海鹏[1,2] 顾峥嵘[1,2] 刘云吉[1,2] 徐菁[1,2] 颜家骅[1,2] 张炯豪[1,2] 彭程[1,2] 

机构地区：[1]上海市静安区中心医院 [2]复旦大学附属华山医院静安分院骨科,上海200040

出　　处：《中国修复重建外科杂志》2015年第4期416-419,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市静安区卫生计生系统第3批"十百千"卫生人才培养资助项目(JWRC2014Q03)~~

摘　　要：目的探讨手术治疗踝关节骨折伴三角韧带损伤的疗效。方法 2010年1月-2013年1月,收治11例踝关节骨折伴三角韧带损伤患者。其中男7例,女4例;年龄18~72岁,平均38.2岁。受伤至手术时间为6 h^7 d,平均4 d。踝关节骨折根据Lauge-Hansen分型标准:旋前-外旋型5例,旋后-外旋型4例,旋前-外展型2例。踝关节彩色多普勒超声及MRI检查证实三角韧带断裂。麻醉后行外翻应力试验、距骨外翻倾斜试验和前抽屉试验均为阳性。踝关节骨折行切开复位内固定,探查并修复三角韧带。结果术后切口均Ⅰ期愈合,无感染等手术相关并发症发生。患者均获随访,随访时间12~18个月,平均13.3个月。X线片复查示,骨折均解剖复位,内固定物位置满意,踝关节各骨对应关系无异常,下胫腓联合关系正常;骨折均愈合,愈合时间6~8周,平均7.6周。术后3~6个月复查踝关节MRI示三角韧带形态正常。按美国足踝外科协会(AOFAS)评分:获优6例,良3例,可1例,差1例,优良率81.8%。结论对于踝关节骨折伴三角韧带损伤,切开复位内固定骨折同时修补三角韧带,可最大程度恢复踝关节内侧稳定结构。Objective To evaluate the effectiveness of repairing the deltoid ligament with ankle fracture. Methods Between January 2010 and January 2013, 11 patients with ankle fractures associated with deltoid ligament injury were treated. There were 7 males and 4 females, with an average age of 38.2 years（range, 18-72 years）. The interval between injury and operation was 6 hours to 7 days（mean, 4 days）. According to Lauge-Hansen classification, ankle fracture was rated as pronation-external rotation type in 5 cases, as supination-external rotation type in 4 cases, and as pronation-abduction type in 2 cases. The MRI and color Doppler ultrasound showed deltoid ligament rupture. The results of valgus stress test, talus valgus tilt test, and anterior drawer test after anesthesia were all positive. Fracture was treated by open reduction and internal fixation, and deltoid injury was repaired. Results All incisions healed primarily. All patients were followed up 12-18 months（mean, 13.3 months）. The X-ray films showed anatomical reduction, good position of internal fixation and stable distal tibiofibular syndesmosis. The mean fracture union time was 7.6 weeks（range, 6-8 weeks）. MRI at 3 months after operation showed normal shape of the deltoid ligament. According to American Orthopaedic Foot and Ankle Society（AOFAS） score, the results were excellent in 6 cases, good in 3 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 81.8%. Conclusion It is an effective method to treat ankle fracture with deltoid ligament injury by open reduction and internal fixation of ankle fracture and repair of the deltoid ligament injury, which can effectively rebuild medial instability and has satisfactory effectiveness.

关 键 词：踝关节骨折 三角韧带损伤 内固定 韧带修复 

分 类 号：R687.3[医药卫生—骨科学]