踝损伤伴三角韧带完全断裂的手术治疗  

Surgical treatment of ankle injuries accompanied with complete rupture of deltoid ligament

作　　者：明晓锋[1] 曹向阳[1] 王振[1] 王社言 冯彦江[1] 马言 张海波[1] 俞光荣[2] MING Xiao-feng;CAO Xiang-yang;WANG Zhen;WANG She-yan;FENG Yan-jiang;MA Yan;ZHANG Hai-bo;YU Guang-rong(Luoyang Orthopaedic Hospital,Luoyang 450000,China;Tongji Hospital,Tongji University,Shanghai 200000,China)

机构地区：[1]河南省洛阳正骨医院,河南洛阳450000 [2]上海同济大学同济医院,上海200065

出　　处：《中国矫形外科杂志》2023年第16期1519-1522,共4页Orthopedic Journal of China

摘　　要：[目的]探讨踝损伤伴三角韧带(deltoid ligament,DL)完全断裂的手术治疗方法及临床效果。[方法]2018年1月—2020年12月治疗的25例踝损伤伴DL完全断裂患者,首先复位固定骨折,修复下胫腓,确认仍有明显内侧不稳,采用双带线锚钉加强修复DL。评价临床与影像结果。[结果]所有患者均顺利完成手术,无严重并发症,随访时间平均(19.6±6.8)个月。随时间推移(术前,术后6个月和末次随访),VAS评分[(7.8±0.7),(2.0±0.6),(1.0±0.8),P<0.05]显著减少,而AOSAF评分[(53.0±7.2),(83.8±5.7),(93.0±2.9),P<0.05]和踝背伸-跖屈ROM[(22.3±2.3)°,(44.1±4.8)°,(59.4±2.4)°,P<0.05]显著增加,踝内-外翻ROM显著减少[(37.9±1.9)°,(27.6±1.2)°,(28.1±1.4)°,P<0.05]。影像方面,术后影像显示所有患者骨折均达到满意复位,关节面平整。术后内侧净间隙显著减小[(5.4±0.6)mm,(3.2±0.3)mm,(3.3±0.4)mm,P<0.05],无显著关节退变。[结论]双带线锚钉加强修复DL治疗伴有明显内侧不稳的踝损伤可以更好恢复踝关节稳定性,利于早期功能锻炼,提升临床疗效。[Objective]To investigate the surgical treatment and its clinical outcomes for ankle injuries accompanied by complete rupture of deltoid ligament(DL).[Methods]From January 2018 to December 2020,a total of 25 patients received surgical treatment for ankle injuries and DL complete fracture.After the fractures were reduced and fixed,and the inferior tibiofibular syndesmosis injury was repaired,the DL was repaired with two suture anchors if significant medial instability was proved.Clinical and imaging documents were evaluated.[Results]All patients were operated on successfully without serious complications,and followed-up time was(19.6±6.8)months on an average.With time elapsed preoperatively,6 months postoperatively and the latest follow-up,the VAS score for pain decreased significantly[(7.8±0.7),(2.0±0.6),(1.0±0.8),P<0.05],while the AOSAF score[(53.0±7.2),(83.8±5.7),(93.0±2.9),P<0.05]and ankle dorsal extensionplantar flexion ROM[(22.3±2.3)°,(44.1±4.8)°,(59.4±2.4)°,P<0.05]increased significantly,and ankle inversion-eversion ROM significantly reduced[(37.9±1.9)°,(27.6±1.2)°,(28.1±1.4)°,P<0.05].In terms of imaging,postoperative radiographs showed satisfactory reduction of fractures in all patients with smooth articular surface.The medial clear space(MCS)significantly reduced postoperatively[(5.4±0.6)mm,(3.2±0.3)mm,(3.3±0.4)mm,P<0.05],and no significant joint degeneration was noted in anyone of them at the latest follow-up.[Conclusion]DL repair with two suture anchors does restore ankle joint stability better for ankle injuries with obvious medial instability,which is conducive to early functional exercise and improve clinical consequences.

关 键 词：踝关节损伤 骨折 三角韧带 带线锚钉 修复 

分 类 号：R683.42[医药卫生—骨科学]