外踝骨折合并内侧副韧带损伤的治疗  

Treatment of lateral malleolous fractures accompanied with deltoid ligament rupture

作　　者：陈黎[1] 钟孝政[1] 罗永雪 秦昊[1] 鲍全伟 赵玉峰[1] 沈岳[1] 宗兆文[1] 

机构地区：[1]第三军医大学大坪医院创伤外科,重庆400042

出　　处：《中国骨与关节损伤杂志》2016年第10期1053-1055,共3页Chinese Journal of Bone and Joint Injury

基　　金：全军"十二五"全军后勤科研项目重大专项(BWS13J012;AWS14L012)

摘　　要：目的观察外踝骨折合并内侧副韧带损伤时不修复损伤的韧带是否会损害患者的本体感觉,并探讨修复韧带辅助以综合运动康复是否有助于患者的功能恢复。方法回顾性分析自2009-06—2013-08诊治的37例外踝骨折合并内侧副韧带损伤但未修复韧带(A组)和94例旋后-外旋型踝部骨折(B组)患者的临床资料,并分析自2013-09—2015-07诊治的9例外踝骨折合并内侧副韧带损伤修复损伤韧带(C组)和32例旋后-外旋型踝部骨折(D组)患者的临床资料。采用星形偏移平衡试验(SEBT)和Cumberland踝部不稳定评分(CAIT)评估患者的功能恢复结局。结果所有骨折愈合良好,A组的SEBT和CAIT均低于B组,差异均有统计学意义(P<0.05)。C组的SEBT和CAIT和D组比较,差异均无统计学意义(P>0.05)。结论外踝骨折合并内侧副韧带损伤时不修复损伤韧带容易导致本体感觉不平衡和功能性踝关节不稳,修复损伤韧带并辅以综合运动康复可有效地降低这些并发症的发生率。Objective To observe whether untreated deltoid ligament rupture accompanying ankle fractures has adverse effects on patients and to investigate whether these patients would benefit from ligament-to-bone repair and comprehensive postoperative functional rehabilitation. Methods The patients with lateral malleolous fractures accompanied with deltoid ligament rupture and the patients with supination external rotation ankle fractures were retrospectively analyzed and categorized into four groups： lateral malleolous fractures accompanied with deltoid ligament rupture（group A, 37 cases, without deltoid ligament repaired, from June 2009 to August 2013）, supination external rotation ankle fractures （group B, 94 cases, June 2009 to August 2013）, lateral malleolous fractures accompanied with deltoid ligament rupture （group C, 9 cases, with deltoid ligament repaired and comprehensive postoperative functional rehabilitation, September 2013 to July 2015）, supination external rotation ankle fractures （group D, 32 cases, September 2013 to July 2015）. Star excursion balance test （SEBT） and Cumberland ankle instability tool （CAIT） were employed to assess the outcome of patients. Results All fractures in the four groups healed well. SEBT and CAIT scores in group A were lower significantly lower than those in group B （P 〈0.05）, there were no statistically significant differences in SEBT and CAIT scores between group C and group D（P 〉0.05）. Conclusion In patients with ankle fractures combined with deltoid ligament injury, untreated deltoid ligament rupture has higher chance to develop proprioceptive imbalance and functional ankle instability. Ligament-to-bone repair of deltoid ligament and comprehensive postoperative functional rehabilitation could decrease the incidence of proprioceptive imbalance and functional ankle instability.

关 键 词：踝部骨折 内侧副韧带损伤 修复 本体感觉 

分 类 号：R686[医药卫生—骨科学]