一期同时修复踝关节周围骨折合并Ⅲ度外侧韧带损伤  

One-stage repair of ankle fracture combined with grade Ⅲ injury to lateral ligament

作　　者：余黎[1] 汪冰[1] 谢哲 邓玲珑[1] 章冲[1] 魏驰[1] 邓凯[1] 余国荣[1] 祝少博[1] Yu Li;Wang Bing;Xie Zhe;Deng Linglong;Zhang Chong;Wei Chi;Deng Kai;Yu Guorong;Zhu Shaobo(Department of Trauma and Orthopaedic Microsurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China)

机构地区：[1]武汉大学中南医院创伤与显微骨外科,430071

出　　处：《中华创伤骨科杂志》2019年第7期581-585,共5页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省自然科学基金面上项目(2016CFB455);教育部"留学回国人员科研启动基金"(230303);武汉大学中南医院培育基金(ZNPY2017037).

摘　　要：目的探讨踝关节周围骨折合并Ⅲ度外侧韧带损伤同时一期修复的手术疗效。方法回顾性研究2015年4月至2017年12月武汉大学中南医院创伤修复/足踝外科收治的23例踝关节周围骨折合并外侧韧带损伤患者资料,男15例,女8例;年龄18~65岁,平均37.8岁。所有患者术中骨折经处理后,22例韧带止点撕裂用锚钉对断裂的韧带进行修复,1例韧带中部撕裂应用Internal Brace修复。术后定期复查X线片,通过体格检查及Sefton关节稳定性分级评价踝关节及距下关节稳定性,并应用Karlsson-Peterson评分、美国足踝外科协会(AOFAS)踝-后足评分评价踝足部功能和疼痛。结果所有患者术后获12~24个月(平均13.9个月)随访。本组患者骨折愈合时间6~24周(平均10.1周)。未出现外侧及距下关节慢性不稳定。其中2例出现内侧距骨软骨损伤,于伤后1年行微骨折手术治疗;1例出现距下关节炎,伤后14个月行距下关节融合术。Karlsson-Peterson评分平均为84.6分;AOFAS踝-后足评分平均为93.7分,其中优19例,良4例;Sefton关节稳定性分级:1级9例,2级14例。结论一期同时修复踝关节周围骨折合并的Ⅲ度外侧韧带损伤,有助于踝关节和距下关节的稳定,改善踝关节功能。Objective To investigate the surgical outcomes of one-stage repair of the ankle fracture combined with grade Ⅲ injury to the lateral ligament. Methods From April 2015 to December 2017, 23 patients with ankle fracture and lateral ligament injury were treated at Department of Traumatic Reconstruction Surgery/Foot and Ankle Surgery, Zhongnan Hospital. There were 15 males and 8 females, aged from 18 to 65 years (average, 37.8 years). After intraoperative treatment of their fractures, 22 ruptures of the ligamentous insertion were repaired with suture anchor and one rupture of the middle ligament with Internal Brace. Routine postoperative X-rays, physical examination and Sefton grading system were used to evaluate the stability of the ankle joint and the subtalar joint. The Karlsson-Peterson and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the function and pain of the ankle. Results The follow-up for this cohort ranged from 12 to 24 months (average, 13.9 months). The bone union time ranged from 6 to 24 weeks, averaging 10.1 weeks. There was no chronic instability of lateral ankle or subtalar joint in all the cases. Two cases developed osteochondral lesion of the medial talus which was treated with micro-fracture surgery one year after injury;one case suffered subtalar arthritis which was treated by subtalar arthrodesis 14 months after injury. Their Karlsson-Peterson scores averaged 84.6 points and AOFAS ankle-hindfoot scores 93.7 points with 19 excellent and 4 good cases. The Sefton grading system gave 9 cases of grade Ⅰ and 14 ones of grade Ⅱ. Conclusion One-stage repair of the ankle fracture combined with grade Ⅲ injury to the lateral ligament can lead to the stability of the ankle joint and the subtalar joint and improved function of the ankle.

关 键 词：踝关节 骨折 外侧韧带 踝 外科手术 一期修复 

分 类 号：R687.3[医药卫生—骨科学]