缝合锚修复三角韧带深层治疗混合型内侧损伤踝关节骨折疗效观察  

Effectiveness of repairing the deep layer of deltoid ligament by suture anchor repair method in treatment of mixed medial injury associated with ankle fractures

作　　者：罗刚[1] 倪卫东[1] 郭世航 郭书权[1] LUO Gang;NI Weidong;GUO Shihang;GUO Shuquan(Department of Orthopaedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,P.R.China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《中国修复重建外科杂志》2020年第11期1387-1391,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨在混合型内侧损伤踝关节骨折治疗中修复三角韧带深层的必要性。方法2016年1月—2018年12月,采用外踝接骨板固定、内踝前丘空心螺钉固定、三角韧带深层缝合锚修复方式治疗12例混合型内侧损伤踝关节骨折患者。其中男8例,女4例;年龄18~56岁,平均42岁。根据Lauge-Hansen分型:旋后外旋型11例,旋前外旋型1例;根据Weber分型,均为B型。受伤至手术时间3~6 d,平均4.7 d。术后摄踝关节正侧位及踝穴位X线片,测量踝关节活动度,并采用美国矫形足踝协会(AOFAS)评分、Olerud-Molander评分及疼痛视觉模拟评分(VAS)评价疗效。结果12例患者均获随访,随访时间12~42个月,平均28个月。12例患者均恢复了伤前工作,5例运动损伤患者全部恢复运动功能。所有患者均未诉踝关节内侧持续性疼痛及踝关节不稳。末次随访时,患侧踝关节背伸活动度为9°~25°,平均17.96°,与健侧相差0°~11°,平均4.02°;踝关节跖屈活动度为38°~50°,平均43.90°,与健侧相差0°~7°,平均2.53°。AOFAS评分为88~100分,平均96.7分;OlerudMolander评分为90~100分,平均96.5分;VAS评分为0~3分,平均1.1分。结论在同时存在内踝前丘骨折及三角韧带深层断裂的混合型内侧损伤踝关节骨折中,修复三角韧带深层非常必要,缝合锚修复方式可取得较好疗效。Objective To explore the necessity of repairing the deep layer of deltoid ligament in the treatment of mixed medial injury associated with ankle fractures.Methods Between January 2016 and December 2018,12 patients with mixed medial injury associated with ankle fractures were treated with the fixation of the lateral malleolus by bone plates,the fixation of the anterior colliculus of medial malleolus by cannulated screws,and the repair of the deltoid ligament by suture anchors.There were 8 males and 4 females,with an average age of 42 years(range,18-56 years).According to the Lauge-Hansen classification criteria,there were 11 cases of supination-external rotation type and 1 case of pronation-external rotation type.According to the Weber classification criteria,all cases were type B.The time from injury to operation was 3-6 days,with an average of 4.7 days.In each patient,X-ray films of anteroposterior and lateral views and mortise view of ankle were taken postoperatively.The motion range of ankle joints was observed.The function of the ankle and the outcome of the treatment were evaluated according to the American Orthopaedic Foot and Ankle Society(AOFAS)scoring system,Olerud-Molander scoring system,and the visual analogue scale(VAS)score.Results All cases were followed up 12-42 months(mean,28 months).The 12 patients returned to their pre-injury jobs.Five patients with sports injury completely recovered to their pre-injury motor function.No patient experienced persistent medial ankle pain or ankle instability.At last follow-up,the ankle range of motion in dorsiflexion was 9°-25°(mean,17.96°),which was 0°-11°(mean,4.02°)less than that in normal side;the range of motion in plantar flexion was 38°-50°(mean,43.90°),which was 0°-7°(mean,2.53°)less than that in normal side.The AOFAS score was 88-100(mean,96.7);the Olerud-Molander score was 90-100(mean,96.5);the VAS score was 0-3(mean,1.1).Conclusion It is necessary to repair the deep layer of deltoid ligament in the mixed medial injuries associated with ankle

关 键 词：踝关节骨折 前丘骨折 三角韧带损伤 修复 

分 类 号：R687.3[医药卫生—骨科学]