外踝骨折合并三角韧带断裂一期手术治疗临床疗效观察  

Clinical effect of one-stage repair of lateral malleolus fractures combined with deltoid ligament rupture

作　　者：封海 赵敦旭 封景 孟晔[3] FENG Hai;ZHAO Dun-xu;FENG Jing;MENG Ye(Department of Orthopaedic Trauma,Qingdao Chengyang District People's Hospital(Qingdao Hospital Affiliated to Shandong First Medical University),Qingdao,Shandong 266108,China)

机构地区：[1]青岛市城阳区人民医院(山东第一医科大学附属青岛医院)创伤骨科,山东266108 [2]中国人民解放军海军第971医院,山东266011 [3]青岛市市立医院骨关节与运动医学科,山东266011

出　　处：《中国骨与关节损伤杂志》2021年第8期812-815,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察外踝解剖钢板内固定外踝骨折后同时采用带线锚钉缝合修复三角韧带断裂的临床疗效。方法回顾性分析自2016-08—2018-08诊治的16例外踝骨折合并三角韧带断裂,先作内侧踝关节弧形切口探查损伤的三角韧带,将嵌顿在踝关节间隙内的三角韧带断端牵出,标记三角韧带的浅层和深层。再作外踝纵形切口进行外踝骨折切开复位解剖钢板内固定,置入1枚空心钉稳定下胫腓联合,垂直距骨体中心部置入2枚Anchor带线锚钉缝合固定三角韧带深层,用2枚Anchor带线锚钉于内踝尖前部及下部缝合固定三角韧带浅层。结果16例术后均获得随访,随访时间平均13.2(10~20)个月。随访期间外踝骨折愈合良好,无内固定失败、骨折不愈合、感染等并发症发生,前抽屉试验阴性,无距骨倾斜。末次随访时疼痛VAS评分、踝与后足功能AOFAS评分、内侧踝关节间隙较术前明显改善,差异有统计学意义(P<0.05)。结论明确三角韧带断裂后一期行外踝骨折切开复位内固定与带线锚钉缝合修复三角韧带可以明显缩小内侧踝关节间隙,增加踝关节稳定性,减少因三角韧带损伤导致的踝关节不稳及其他并发症的发生。ObjectiveTo observe the clinical effect of suture with suture anchor in the repair of deltoid ligament rupture after lateral malleolus fractures was fixed with anatomical plate.MethodsSixteen cases of lateral malleolus fractures complicated with deltoid ligament rupture from August 2016 to August 2018 were retrospectively analyzed.First,the injured deltoid ligament was explored through the medial ankle arc incision.The broken end of deltoid ligament embedded in the ankle joint space was pulled out and the superficial and deep layers of deltoid ligament were marked.A cannulated screw was inserted to stabilize the distal tibiofibular syndesmosis.Two anchor screws with thread were placed vertically in the center of talus body to suture and fix the deep layer of deltoid ligament.Two anchor screws with thread were used to suture and fix the superficial layer of deltoid ligament in the anterior and lower part of medial malleolus.ResultsAll patients were followed up for an average of 13.2(10-20)months.During the follow-up period,the fractures of lateral malleolus healed well without internal fixation failure,fracture nonunion,infection and other complications.The anterior drawer test was negative,and there was no talus tilt.At the last follow-up,VAS score of pain,AOFAS score of ankle and hind foot function,medial ankle joint space were significantly improved compared with those before operation(P<0.05).ConclusionOne stage open reduction and internal fixation of lateral malleolus fractures combined with repair of deltoid ligament rupture by suture with suture anchor can significantly reduce the medial ankle joint space,increase the stability of ankle joint,and reduce the occurrence of ankle instability and other complications caused by deltoid ligament injury.

关 键 词：外踝骨折 三角韧带断裂 一期手术 带线锚钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]