三角韧带深层损伤是否影响旋前外旋型踝关节骨折的中期临床疗效  

Does the rupture of the deep layer of deltoid ligament affect the mid-term clinical efficacy of prona-tion-external rotation ankle fracture

作　　者：龚晓峰[1] 杨瀚元 何琦非 李文菁[1] 王岩[1] 李莹[1] 孙宁[1] 赖良鹏[1] 杨磊[1] 武勇[1] Gong Xiaofeng;Yang Hanyuan;He Qifei;Li Wenjing;Wang Yan;Li Ying;Sun Ning;Lai Liang-peng;Yang Lei;Wu Yong(Department of Orthopedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China;Gastrointestinal Neoplasms Center,Neoplasms Hospital,Peking University Beijing 100142,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]北京大学肿瘤医院胃肠肿瘤中心,100142

出　　处：《中华创伤骨科杂志》2020年第4期322-328,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科学技术委员会-首都临床特色应用研究与成果推广(Z171100001017010)。

摘　　要：目的了解三角韧带深层损伤对PER型踝关节骨折中期临床疗效的影响。方法回顾性研究2013年1月至2014年12月北京积水潭医院创伤骨科手术治疗的50例PERⅢ度或Ⅳ度骨折患者。其中男37例,女13例;年龄16~68岁,平均30.2岁。根据踝关节内侧损伤类型分为两组:未修复组为内踝三角韧带深层损伤且无内踝骨折患者,未行三角韧带修复手术,共28例;对照组为内踝丘上骨折且三角韧带深层完整患者,行内踝丘上骨折切开复位内固定,共22例。两组患者均行腓骨骨折切开复位内固定和下胫腓螺钉固定。比较两组患者术后6个月以上影像学检查的内踝间隙和下胫腓间隙,以及中期随访的美国足踝外科协会的(AOFAS)的踝-后足评分和疼痛视觉模拟评分(VAS)。结果两组患者的性别、年龄、出现踝关节半脱位或脱位时的表现方式差异有统计学意义(P<0.05)。两组患者在损伤暴力程度、腓骨骨折线高度、是否完全脱位、后踝骨折率、后踝固定率、内固定物取出率、手术时间等差异均无统计学意义(P>0.05)。38例完成术后6个月影像学检查,21例未修复组的内踝间隙为3.7 mm,下胫腓间隙为4.5 mm;17例对照组的内踝间隙为3.4 mm;下胫腓间隙为4.4 mm。术后约3年时随访,未修复组和对照组的平均AOFAS评分分别为98.3分和94.6分,平均VAS评分分别为0.4分和1.5分。术后约5年时随访,未修复组和对照组的平均AOFAS评分分别为97.1分和93.6分,平均VAS评分分别为0.5分和1.2分。对于年龄<45岁的患者,术后约3、5年时随访的AOFAS评分、VAS评分与三角韧带完整与否均无相关性(P>0.05)。年龄与术后5年随访时AOFAS评分(P=0.021)相关。结论对于PER型Ⅲ、Ⅳ度踝关节骨折,在腓骨骨折及下胫腓螺钉固定后,残留三角韧带深层损伤不会影响45岁以内患者的中期疗效。Objective To explore whether the deep deltoid ligament(DL)rupture affects the mid-term clinical efficacy of pronation-external rotation(PER)ankle fracture or not.Methods A ret-rospective study was conducted to analyze the clinical data of 50 patients with ankle fracture of PER typeⅢorⅣwho had been treated at Department of Orthopedic Trauma,Beijing Jishuitan Hospital from January 2013 to December 2014.They were 37 males and 13 females with an average age of 30.2 years(from 16 to 68 years).According to their type of medial ankle injury,the patients were divided into 2 groups.The experimental group,consisting of 28 patients with deep DL rupture but no medial ankle fracture,did not undergo DL repair operation;the control group,consisting of 22 patients with supracollicular medial malleolar(SMM)fracture but no deep DL rupture,underwent open reduction and internal fixation(ORIF)for SMM.Both groups were treated with ORIF of fibular fracture in addition to syndesmosis screw fixation.The 2 groups were compared in terms of the medial malleolus space and distal tibiofibular space on the imaging exams at more than 6 months,and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores and visual analog scale(VAS)pain scores at the mid-term follow-ups.Results The differences between the 2 groups in gender,age and mode of concomitant subluxation or dislocation were statistically significant(P<0.05),but there were no sig-nificant differences between the 2 groups in injury violence,height of fibular fracture line,presence of total dis-location,rate of posterior malleolus fracture,rate of posterior malleolus fixation,implant removal,or operation time(P>0.05).Imaging exams were conducted for 38 patients at 6 or more months after surgery.The medial malleolus space was 3.7 mm and the distal tibiofibular space 4.5 mm for the 21 cases in the experimental group;the medial malleolus space was 3.4 mm and the distal tibiofibular space 4.4 mm for the 17 cases in the control group.The 3-year follow-up AOFAS scores of th

关 键 词：踝关节 骨折 骨折固定术 内 三角韧带 

分 类 号：R687[医药卫生—骨科学]