锚钉在修复踝关节骨折伴三角韧带损伤中的疗效  

The therapeutic evaluation of suture anchors in repairing ankle fracture with deltoid ligament injury

作　　者：任永安 李俊[1] 杨立锋 杨盼 杨毅[4] REN Yongan;LI Jun;YANG Lifeng;YANG Pan;YANG Yi(Department of Pain,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Orthopaedics,Xichang People's Hospital,Xichang 615000,Schuan,China;Department of Orthopaedics,The Luonan Hospital in Shanxi Province,Luonan 726100,Shanxi,China;Department of Orthopaedics,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830062,China)

机构地区：[1]四川大学华西医院疼痛科,四川成都610041 [2]西昌市人民医院骨科,四川西昌615000 [3]洛南县医院骨科,陕西洛南726100 [4]新疆医科大学第一附属医院,新疆乌鲁木齐830062

出　　处：《西部医学》2024年第10期1505-1510,共6页Medical Journal of West China

基　　金：自治区科技支疆项目计划项目(骨力学生物学协同创新平台)(2020E0285)。

摘　　要：目的探讨应用缝合锚结合切开复位内固定在踝关节骨折伴三角韧带损伤中的临床疗效。方法选取2012年10月1日-2016年8月12日在西昌市人民医院住院诊断为踝关节骨折合并三角韧带损伤并行骨折切开复位内固定手术治疗的患者40例行回顾性分析,将纳入者分为三角韧带修复组和对照组(未修复组),每组20例。三角韧带修复组应用缝合锚修复三角韧带者;未修复组术中未行三角韧带修复术,术后辅助石膏固定靠其自行修复。术后随访,术后一年行X线检查测量双下肢重力应力位内踝间隙,并将患侧与健侧对比;同时应用美国足踝骨科协会(AOFAS)的足踝评分系统评价手术疗效。结果术后随访12~22个月(平均14.5个月),均无感染等并发症发生。术后一年三角韧带修复组患侧的重力应力位内踝间隙为(3.47±0.32)mm,健侧为(3.44±0.35)mm,两侧比较差异无统计学意义(P>0.05);未修复组患侧的内踝间隙(3.74±0.34)mm,健侧为(3.33±0.29)mm,两侧比较差异有统计学意义(P<0.05);三角韧带修复组的患侧内踝间隙明显小于对照组(P<0.05)。三角韧带修复组的美国足踝骨科协会(AOFAS)足踝评分结果为:优6例,良10例,可2例,差2例,总的优良率为80%;而未修复组的评分为:优4例,良7例,可5例,差4例,总的优良率为55%;一年后患者足踝评分情况可见三角韧带修复组的远期疗效优于对照组(P<0.05)。结论三角韧带对踝关节的稳定性有重要意义,在合并三角韧带损伤的踝关节骨折中应用带线锚钉修复三角韧带的效果满意,随访中未出现内踝间隙明显增宽,而未修复三角韧带者会出现内踝间隙明显增宽。Objective To explore the clinical effect of suture anchor combined with open reduction internal fixation in the treatment of ankle joint fracture with triangular ligament injury.Methods A total of 40 patients hospitalized in our hospital from October 2012 to August 2016 who were diagnosed with ankle fracture complicated with deltoid ligament injury and treated with open reduction and internal fixation for fracture were selected and divided into the deltoid ligament repair group and the control group(unrepaired group),with 20 cases in each group.In the deltoid ligament repair group,suture anchors were used to repair the deltoid ligament.In the unrepaired group,no triangular ligament repair was performed during the operation,and the plaster were used after the operation.One year after surgery,X-ray examination was performed to measure the medial malleolar space at the gravity stress position of lower limbs,and the affected side was compared with the healthy side.At the same time,American Orthopaedic Association(AOFAS)foot and ankle scoring system was used to evaluate the surgical effect.Results Postoperative follow-up was 12 to 22 months(mean 14.5 months),and no complications occurred such as infection.The gravity stress position of medial malleolus space was(3.47±0.32)mm on the affected side and(3.44±0.35)mm on the healthy side in the triangular ligament repair group one year after surgery,and there was no statistical difference between the two sides(P>0.05).While,the medial malleolus space in the unrepaired group was(3.74±0.34)mm on the affected side and(3.33±0.29)mm on the healthy side,and there were statistically significant differences between the two sides(P<0.05).In the triangular ligament repair group,the AOFAS scores were excellent in 6 cases,good in 10 cases,fair in 2 cases,poor in 2 cases,and the overall excellent and good rate was 80%.While,in the unrepaired group,4 cases were excellent,7 cases were good,5 cases were fair,and 4 cases were poor,the overall excellent and good rate was 55%.Conclusion T

关 键 词：踝关节 骨折 三角韧带 锚钉 内踝间隙 

分 类 号：R687.3[医药卫生—骨科学]