切开复位T形钛板联合带线锚钉内固定治疗单纯后踝骨折合并距腓前韧带损伤的临床研究  

A clinical study of open reduction combined with T-type titanium plate and suture anchor internal fixation in the treatment of posterior malleolus fractures complicated with anterior talofibular ligament injury

作　　者：吕岩 王爱国[2] 马富强[2] 李翔[2] 白玉[2] LV Yan;WANG Aiguo;MA Fuqiang;LI Xiang;BAI Yu(First School of Clinical Medicine,Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China;Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China)

机构地区：[1]河南中医药大学第一临床医学院,河南郑州450046 [2]郑州市骨科医院,河南郑州450052

出　　处：《中医正骨》2023年第1期30-35,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较切开复位T形钛板联合带线锚钉内固定与单纯切开复位T形钛板内固定治疗单纯后踝骨折合并距腓前韧带(anterior talofibular ligament,ATFL)损伤的临床疗效和安全性。方法:回顾性分析48例单纯后踝骨折合并ATFL损伤患者的病例资料,均采用切开复位T形钛板内固定治疗,其中术中采用带线锚钉修复ATFL损伤24例(ATFL修复组)、未修复ATFL损伤24例(ATFL未修复组)。比较2组患者的骨折愈合时间,术前和术后1年的踝部疼痛视觉模拟量表(visual analogue scale,VAS)评分、距骨前移距离,术后1年的美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分,以及并发症发生情况。结果:①骨折愈合时间。ATFL修复组骨折愈合时间与ATFL未修复组比较,差异无统计学意义[(11.83±1.13)周,(11.67±0.82)周,t=0.586,P=0.561]。②踝部疼痛VAS评分。术前,2组患者踝部疼痛VAS评分比较,差异无统计学意义[(6.08±0.72)分,(6.04±0.55)分,t=0.226,P=0.822];术后1年,ATFL修复组患者踝部疼痛VAS评分低于ATFL未修复组[(1.04±0.46)分,(2.54±1.22)分,t=-5.649,P=0.000],2组患者踝部疼痛VAS评分均低于术前(t=32.906,P=0.000;t=14.103,P=0.000)。③距骨前移距离。术前,2组患者距骨前移距离比较,差异无统计学意义[(10.71±1.12)mm,(10.54±1.02)mm,t=0.538,P=0.593];术后1年,ATFL修复组患者距骨前移距离小于ATFL未修复组[(2.25±0.74)mm,(4.88±1.48)mm,t=-7.762,P=0.000],2组患者距骨前移距离均小于术前(t=31.259,P=0.000;t=15.140,P=0.000)。④AOFAS踝与后足功能评分。术后1年,ATFL修复组患者AOFAS踝与后足功能评分高于ATFL未修复组[(92.71±6.56)分,(84.71±6.68)分,t=4.186,P=0.000]。⑤安全性。ATFL修复组1例出现外踝处皮肤感觉减退,ATFL未修复组5例出现慢性踝关节不稳、2例出现距骨骨软骨损伤。2组患者均未出现骨不连、感染、内固定失效等并发症。ATFL修复组并发症发生率低于ATFL�Objective:To compare the clinical efficacy and safety of open reduction combined with T-type titanium plate and suture anchor internal fixation and open reduction combined with T-type titanium plate internal fixation in the treatment of posterior malleolus fractures complicated with anterior talofibular ligament(ATFL)injury.Methods:The medical data of 48 patients with posterior malleolus fractures complicated with ATFL injury,who were treated with open reduction combined with T-type titanium plate internal fixation,were retrospectively analyzed,including 24 cases with ATFL injury repaired by suture anchors(the ATFL repair group)and 24 cases with ATFL injury unrepaired(the ATFL non-repair group).The fracture healing time,ankle pain visual analogue scale(VAS)scores and anterior tibial translocation(ATT)measured before operation and at one year after operation,American Orthopedic Foot and Ankle Society(AOFAS)Ankle-Hindfoot Scale scores measured at one year after operation,and the occurrence of complications were compared between the two groups.Results:①Fracture healing time.There was no significant difference in fracture healing time between the ATFL repair group and the ATFL non-repair group(11.83±1.13 vs 11.67±0.82 weeks,t=0.586,P=0.561).②Ankle pain VAS score.Before operation,there was no significant difference in ankle pain VAS scores between the two groups(6.08±0.72 vs 6.04±0.55 points,t=0.226,P=0.822).One year after operation,the ankle pain VAS score in the ATFL repair group was lower than that in the ATFL non-repair group(1.04±0.46 vs 2.54±1.22 points,t=-5.649,P=0.000).For both groups,the ankle pain VAS scores were lower than those before operation(t=32.906,P=0.000;t=14.103,P=0.000).③ATT.Before operation,there was no significant difference in the ATT between the two groups(10.71±1.12 vs 10.54±1.02 mm,t=0.538,P=0.593).One year after operation,the ATT in the ATFL repair group was smaller than that in the ATFL non-repair group(2.25±0.74 vs 4.88±1.48 mm,t=-7.762,P=0.000).For both groups,the ATT was

关 键 词：踝关节 踝损伤 踝部骨折 外侧韧带 踝 距腓前韧带 骨折固定术 内 缝合锚 临床试验 

分 类 号：R687.3[医药卫生—骨科学]