踝部骨折开放复位内固定是否修复三角韧带

Open reduction and internal fixation with or without deltoid ligament repair for ankle fractures

摘要:

[目的] 比较开放复位内固定（open reduction and internal fixation, ORIF） 是否缝合锚修复三角韧带（deltoid ligament,DL） 治疗踝关节骨折伴DL 损伤的临床效果。[方法] 回顾性分析2015 年1 月—2020 年12 月本院采用ORIF 治疗的踝关部骨折伴DL 断裂的76 例患者的临床资料。依据术前医患沟通结果，38 例ORIF 术中修复DL，另外38 例ORIF 术中未修复DL。比较两组患者围手术期、随访和影像资料。[结果] 76 例患者均顺利完成手术，未发生严重并发症。修复组手术时间、切口总长度和术中失血量显著大于未修复组（P＜0.05）。所有患者均获随访12~28 个月，平均（18.7±4.6） 个月。修复组患者恢复完全负重活动时间显著早于未修复组（P＜0.05）。随术后时间推移，两组踝背伸-跖屈ROM、AOFAS 评分均显著增加（P＜0.05），外翻试验显著改善（P＜0.05），VAS 评分显著减少（P＜0.05）。相应时间点，修复组的AOFAS 评分、踝背伸-跖屈ROM、外翻试验和VAS 评分均显著优于未修复组（P＜0.05），但修复组足内翻-外翻ROM 显著小于未修复组（P＜0.05）。影像方面，修复组骨折复位质量显著优于未修复组（P＜0.05），与术前相比，末次随访时两组MCS 和TT 均显著减少（P＜0.05）。末次随访时修复组MCS 和TT 显著低于未修复组（P＜0.05）。[结论] ORIF 术中采用缝合锚修复DL 有利于改善踝部骨折伴DL 损伤的临床效果。

Abstract:

[Objective] To compare the clinical results of open reduction and internal fixation (ORIF) with or without deltoid ligament(DL) repair by suture anchor for ankle fractures complicated with DL tear. [Methods] A retrospective study was done on 76 patients who re-ceived ORIF for closed ankle fractures accompanied with DL tear in our hospital from January 2015 to December 2020. According to preop-erative doctor-patient communication, 38 patients got DL repaired in ORIF, while the other 38 patients had DL unrepaired. The periopera-tive period, follow-up and imaging data were compared between the two groups. [Results] All the 76 patients had corresponding surgicalprocedures completed successfully without serious complications. The repaired group proved significantly inferior to the unrepaired groupin terms of operation time, total incision length and intraoperative blood loss (P＜0.05). All patients were followed up for 12~28 months, withan average of (18.7±4.6) months, and the repaired group returned to full weight-bearing activity significantly earlier than the unrepairedgroup (P＜0.05). The ankle dorsiflexion-plantarflexion range of motion (ROM), AOFAS scores, valgus test and VAS score significantly im-proved over time in both groups (P＜0.05). The repaired group proved significantly superior to the unrepaired group in terms of AOFASscore, ankle dorsiflexion-plantarflexion ROM, valgus test and VAS score at all time points postoperatively (P＜0.05), whereas the formerhad significantly less foot varus-valgus ROM than the latter (P＜0.05) . In terms of imaging, the repaired group got significantly better quali-ty of fracture reduction than the unrepaired group (P＜0.05). The medial clear space (MCS) and talus tilt (TT) were significantly reduced inboth groups at the latest follow-up compared with those before surgery (P＜0.05), while which in the repaired group were significantly lessthan those in the unrepaired group at the latest follow-up (P＜0.05). [Conclusion] Repairing DL with suture anchor during ORIF does im-prove the clinical outcomes of ankle fractures complicated with DL tear.