旋后外旋Ⅳ度踝关节骨折中三角韧带损伤修复的临床对照研究  

A comparative clinical study on the repair of triangular ligament injury in rotation and external rotation degree Ⅳ ankle fracture

作　　者：张云[1] 周海超[1] 李兵[1] 张明珠[1] 朱辉[1] 于涛[1] 赵有光[1] 杨云峰[1] ZHANG Yun;ZHOU Haichao;LI Bin;ZHANG Mingzhu;ZHU Hui;YU Tao;ZHAO Youguang;YANG Yunfeng(Department of Orthopaedics,Tongji Hospital Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《足踝外科电子杂志》2017年第4期1-6,共6页Electronic Journal of Foot and Ankle Surgery

基　　金：国家自然科学基金资助项目(81472144;81501931)

摘　　要：目的比较分析旋后外旋Ⅳ度踝关节骨折中三角韧带损伤修复与否的临床疗效。方法回顾性分析2013年1月至2016年6月收治并获得随访的35例伴三角韧带损伤的旋后外旋Ⅳ度踝关节骨折患者,其中30例单纯三角韧带损伤,5例内踝骨折合并三角韧带损伤。所有患者均行切开复位内固定术,采用随机对照研究,根据术中是否修复三角韧带分为手术修复组(21例)和不修复组(14例)。两组患者的性别、年龄、致伤原因、伤后至手术时间等一般资料差异均无统计学意义(P>0.05)。记录两组手术时间、AOFAS评分(术后6个月、1年、2年)、内踝间隙、VAS评分、Baird-Jackson评分、并发症发生率。结果 35例患者术后随访21~28个月,平均25.5个月。手术修复组(102.5±11.2)分钟长于不修复组(77.5±7.9)分钟,差异有统计学意义(P<0.05)。末次随访时Baird-Jackson评分系统:手术修复组优良率90.5%,不修复组优良率85.7%。手术修复组术前及末次随访时VAS评分分别为(7.8±1.1)、(2.1±0.5)分,不修复组分别为(7.5±1.2)、(1.8±0.5)分;手术修复组术前及末次随访时内侧踝穴间隙分别为(6.2±1.15)及(3.38±0.4),不修复组分别为5.5±1.35及3.49±0.36,均较术前显著改善,但两组间比较上述指标差异无统计学意义(P>0.05)。末次随访时2.85%的患者出现踝关节不稳定(手术修复组0例,不修复组1例),8.5%的患者X线示创伤性关节炎表现(手术修复组1例,不修复组2例)。手术修复组及不修复组术后6、12、24月AOFAS评分分别为(82.1±6.6,86.2±5.9,91.5±5.8)及(78.1±6.5,83.9±5.6,90.3±5.6),比较两组间并发症及术后AOFAS评分差异均无统计学意义(P>0.05)。结论对于踝关节旋后外旋性Ⅳ度骨折同时伴三角韧带损伤患者,如果骨折复位固定后踝穴稳定,无需修复三角韧带。Objective To evaluate the effect of repairing deltoid ligament in patients with supination-external rotation type Ⅳ ankle fractures. Methods Between January 2013 and June 2016, 35 patients of supination-external rotation type Ⅳ ankle fractures associated with deltoid ligament injury had complete medical records and were included in this study. Among all, 30 cases involved pure deltoid ligament injuries while others also included medial malleolus fractures. All fractures were treated by open reduction and internal fixation. Patients were assigned to the repaired group（21 patients） or the non-repaired group（14 patients） according to whether deltoid ligament injuries were treated during the surgery. No significant difference was found in gender, age, injury pattern, time from injury to operation（P〈0.05）, which was comparable. Medial clear space, visual analogue scale（VAS） score, and American Orthopaedic Foot and Ankle Society（AOFAS） ankle-hindfoot score（6 months, one year, two years after surgery）, Baird-Jackson scoring system and complications were recorded. Results Thirty-five patients were followed up 21-28 months（mean,25.5 months）.The mean duration of operation in the repaired group（102.5±11.2） minutes was significantly longer than that of the non-repaired group（77.5±7.9） minutes（P〈0.05）. Baird-Jackson scoring system： the excellent rate of the repaired group was 90.5%, and the non-repaired group was 85.7% during the last follow-up. The VAS scores of preoperative and final follow-up were 7.8 ± 1.1 and 2.1 ± 0.5 in the repaired group while（7.5±1.2） and（1.8±0.5） in the non-repaired group, respectively. The medial clear space of preoperative and final follow-up in the repaired group was 6.2 ± 1.15 and 3.38 ± 0.4, respectively, and 5.5 ± 1.35 and 3.49 ± 0.36 in the non-repair group, which were significantly improved. However, none of them showed significant difference between the two groups（P〈0.05）. At the last follow-up, 2.85 percent of the pa

关 键 词：踝关节骨折 旋后外旋 三角韧带 疗效 

分 类 号：R687.3[医药卫生—骨科学]