踝关节骨折合并三角韧带完全断裂的手术治疗  

Surgical treatment of ankle fracture with complete rupture of deltoid ligament

作　　者：邓文杰 李越[1] 赵以瑜 刘杰 许京伟 盛奎升 DENG Wenjie;LI Yue;ZHAO Yiyu;LIU Jie;XU Jingwei;SHENG Kuisheng(Orthopaedics Department,Rizhao Hospital of TCM,Rizhao 276800,China)

机构地区：[1]日照市中医医院骨科,山东日照276800

出　　处：《临床医学研究与实践》2022年第32期21-24,共4页Clinical Research and Practice

基　　金：济宁医学院教师科研扶持基金(No.JYFC2019FKJ104);日照市科技研发项目(No.KJYF2019340)。

摘　　要：目的探讨踝关节骨折合并三角韧带完全断裂的手术治疗和临床疗效。方法2015年9月至2021年9月在日照市中医医院接受手术治疗的310例踝关节骨折患者中,12例在骨折复位内固定的同时行三角韧带修复手术,其中男9例,女3例;年龄15~70岁,平均44岁;Lauge-Hansen分型:旋后-外旋型Ⅳ度损伤1例,旋前-外旋型Ⅲ度损伤8例,旋前-外旋型Ⅳ度损伤2例,旋前-外展型Ⅲ度损伤1例。术中完成骨折固定后进行外旋应力试验,若发现踝关节不稳定,则给予带线锚钉缝合修补三角韧带。开展术后随访,使用美国骨科足踝学会(AOFAS)踝-后足评分评定临床效果;使用视觉模拟评分(VAS)评估疼痛程度;使用简明健康状况调查量表(SF-36)评定患者的生命质量(包括身体疼痛)。结果12例患者均达到Ⅰ期愈合。12例患者的术后随访时间为12~72个月,平均24个月;骨折愈合时间为10~18周,平均14.3周。术后末次随访时,患者的AOFAS踝-后足评分为83~98分,平均90.67分;VAS评分为0~10分,平均1.17分;SF-36评分为82~97分,平均90.33分;无患者发生踝关节不稳定。结论对于合并三角韧带深层完全断裂的踝关节骨折,采用带线锚钉一期修补缝合三角韧带,能够取得满意的临床疗效。Objective To investigate the surgical treatment and clinical effect of ankle fracture with complete rupture of deltoid ligament.Methods Among 310 patients with ankle fractures who received surgical treatment in Rizhao Hospital of TCM From September 2015 to September 2021,12 patients underwent deltoid ligament repair while fracture reduction and internal fixation,including 9 males and 3 females;the average age was 44 years old,ranging from 15 to 70 years old;the Lauge-Hansen classifications were as follows:1 case of supination-external rotation typeⅣdegree injury,8 cases of pronation-external rotation typeⅢdegree injury,2 cases of pronation-external rotation typeⅣdegree injury,1 case of pronation-abduction typeⅢdegree injury.The external rotation stress test was carried out after the fracture fixation was completed during the operation.If the ankle joint was found to be unstable,the deltoid ligament was repaired with threaded rivet suture.Postoperative follow-up was carried out,and the clinical effect was evaluated with the American Orthopedic Foot and Ankle Society(AOFAS)ankle posterior foot score;Visual Analogue Scale(VAS)was used to assess the degree of pain;the 36-Item Short Form Health Survey(SF-36)was used to assess patients'quality of life(including body pain).Results Twelve patients achieved stageⅠhealing.Twelve patients were followed up for 12 to 72 months,with an average of 24 months;the healing time of fracture was 10-18 weeks,with an average of 14.3 weeks.At the last follow-up,the AOFAS ankle hind foot score of the patient was 83-98 points,with an average of 90.67 points;VAS score is 0-10 points,with an average of 1.17 points;the score of SF-36 is 82-97 points,with an average of 90.33 points;no patient had ankle instability.Conclusion For ankle fracture combined with deep complete rupture of deltoid ligament,one-stage repair and suture of deltoid ligament with suture rivet can achieve satisfactory clinical efficacy.

关 键 词：踝关节骨折 三角韧带完全断裂 外科手术 

分 类 号：R687.4[医药卫生—骨科学]