伴三角韧带断裂的三踝骨折术中三角韧带处理策略下病情转归的差异性研究  

Differences in the prognosis of patients with trimalleolar fractures accompanied by the triangular ligament rupture under the treatment strategy of triangular ligament during surgery

作　　者：宋国明 马传飞 董孝龙 王宏修 SONG Guo-ming;MA Chuan-fei;DONG Xiao-long;WANG Hong-xiu(Department of Orthopedics,the Fourth People's Hospital of Shangqiu,Shangqiu 476100,Henan,CHINA;First Department of Orthopedics,the Second People's Hospital of Xinxiang,Xinxiang 453000,Henan,CHINA)

机构地区：[1]商丘市第四人民医院骨科,河南商丘476100 [2]新乡市第二人民医院骨一科,河南新乡453000

出　　处：《海南医学》2025年第4期476-481,共6页Hainan Medical Journal

基　　金：2020年度河南省医学科技攻关计划联合共建立项项目(编号:LHGJ20201242)。

摘　　要：目的探讨伴三角韧带断裂的三踝骨折术中三角韧带处理策略对病情转归的影响。方法选取2020年10月至2023年12月商丘市第四人民医院收治的61例伴三角韧带断裂的三踝骨折患者进行回顾性研究,根据三角韧带处理策略不同分组,其中30例仅行切开复位钢板螺钉内固定者作为对照组,31例行切开复位钢板螺钉内固定和三角韧带修复者作为研究组。比较两组患者的切口长度、手术时间、失血量、住院时间、下地时间、完全负重时间,术前、术后1个月和6个月踝关节静息疼痛视觉模拟评分法(VAS)评分、美国矫形足踝协会评分系统(AOFAS)评分、关节活动和影像学指标[踝关节内侧关节间隙(MCS)、距骨倾斜角(TT)]以及术后1个月和6个月关节活动情况(踝背伸-跖屈度、踝足内翻-外翻度);同时比较两组患者术后6个月行走时的疼痛程度、功能优良率和术后住院期间的并发症发生率。结果研究组患者的切口长度、手术时间、失血量分别为(9.83±1.92)cm、(96.00±10.38)min、(112.59±15.48)m L,明显长(多)于对照组的(7.40±2.13)cm、(73.20±14.57)min、(98.60±17.35)m L,住院时间、下地时间、完全负重时间分别为(11.20±2.78)d、(9.00±2.56)周、(11.60±1.79)周,明显短于对照组的(14.67±3.19)d、(11.82±3.01)周、(14.15±2.36)周,差异均有统计学意义(P<0.05);研究组患者术后1个月和6个月的静息VAS评分分别为(1.72±0.51)分、(0.51±0.14)分,明显低于对照组的(2.59±0.76)分、(0.93±0.27)分,AOFAS评分分别为(92.40±2.49)分、(97.02±0.85)分,明显高于对照组的(88.57±3.75)分、(93.84±1.33)分,差异均有统计学意义(P<0.05);研究组患者术后1个月和6个月的踝背伸-跖屈度分别为(9.02±2.57)°、(12.25±1.88)°,明显高于对照组的(7.86±2.20)°、(10.05±1.61)°,踝足内翻-外翻度分别为(8.57±2.13)°、(11.94±2.56)°,明显低于对照组的(9.78±2.05)°、(13.52±2.30)°,差异均有统计学意�Objective To investigate the effect of treatment strategy for the triangular ligament during surgery on the prognosis of patients with trimalleolar fractures accompanied by triangular ligament rupture.Methods A retrospective study was conducted to select 61 patients with trimalleolar fracture accompanied by triangular ligament rupture admitted to the Fourth People's Hospital of Shangqiu from October 2020 to December 2023.The patients were grouped according to different treatment strategies of triangular ligament.Among them,30 patients who only underwent open reduction and internal fixation with steel plate screws were selected as the control group,and 31 patients who underwent open reduction and internal fixation with steel plate screws and repair of the triangular ligament were selected as the study group.The incision length,operation time,blood loss,length of hospital stay,time to get out of bed,and time to fully bear weight were compared between the two groups,as well as preoperative,postoperative 1-month,and 6-month Visual Analogue Scale(VAS)scores for resting pain in the ankle joint,American Orthopedic Foot and Ankle Society scoring system(AOFAS)scores,joint mobility and imaging indicators(medial compartment space[MCS]of the ankle joint,talus tilt angle[TT]),and postoperative 1-month and 6-month joint mobility(ankle dorsiflexion-plantarflexion,an-kle inversion-eversion).At the same time,the pain level during walking,the rate of excellent and good function,and the incidence of complications during hospitalization were compared between the two groups of patients at 6 months after surgery.Results The incision length,operation time,and blood loss in the study group were(9.83±1.92)cm,(96.00±10.38)min,and(112.59±15.48)mL,respectively,which were significantly longer(more)than(7.40±2.13)cm,(73.20±14.57)min,and(98.60±17.35)mL in the control group;the length of hospital stay,time to get out of bed,and time to ful-ly bear weight were(11.20±2.78)days,(9.00±2.56)weeks,and(11.60±1.79)weeks,respectively,which were

关 键 词：三角韧带断裂 三踝骨折 病情转归 疼痛 修复 

分 类 号：R683.42[医药卫生—骨科学]