踝骨折合并三角韧带损伤术中是否修复韧带比较

Open reduction and internal fixation with or without ligament repair for ankle fracture complicated with deltoid ligament tear

摘要:

[目的] 比较踝骨折伴三角韧带损伤开放复位内固定 （open reduction and internal fixation, ORIF） 术中是否修复三角韧带 （deltoid ligament repair, DLR） 的临床结果。[方法] 回顾性分析 2020 年 6 月—2023 年 5 月本科 ORIF 治疗踝关节骨折伴三角韧带损伤 102 患者的临床资料。据术前医患沟通结果，54 例术中行 DLR（修复组），48 例术中未行 DLR（未修复组）。比较两组围手术期、随访及影像指标。[结果] 102 例患者均成功手术，修复组的手术时间 [(110.0±12.7) min vs (104.2±12.0) min, P=0.020]、切口长度 [(8.5±2.3) cm vs (6.8±1.9) cm, P＜0.001] 均显著长于未修复组，但前者的术中 X 线透视次数 [(8.0±2.0) 次 vs (12.0±4.0) 次, P＜0.001]、住院时间 [(13.5±3.1) d vs (17.2±2.8) d, P＜0.001] 及下地行走时间 [(14.7±4.2) d vs (20.5±4.7) d, P＜0.001] 均显著优于未修复组。随访时间平均 （19.5±3.8） 个月，修复组恢复完全负重活动时间显著早于未修复组 [(78.6±16.0) d vs (92.0± 20.5) d, P＜0.001]。末次随访时修复组的 AOFAS 评分 [(93.5±5.0) vs (91.4±5.3), P=0.042]、足背伸-跖屈 ROM [(16.0±2.5)° vs (14.5± 2.4)°, P=0.003] 及内-外翻 ROM [(17.5±2.7)° vs (16.0±2.3)°, P=0.003] 均显著优于未修复组。影像方面，修复组的骨折复位质量、 距骨小腿角（talocrural angle, TCA）、术后即刻踝内侧净间隙（medial clear space, MCS）、胫腓净间隙（tibiofibular clear space, TF- CS）均显著优于未修复组（P＜0.05）。[结论]修复 DL 损伤能增强踝骨折 ORIF 的疗效，有利于踝关节功能改善。

Abstract:

[Objective] To compare the clinical consequence open reduction and internal fixation (ORIF) with or without deltoid ligament repair (DLR) for ankle fractures complicated with deltoid ligament injury. [Methods] A retrospective study was conducted on 102 patients who underwent ORIF for ankle fractures complicated with deltoid ligament injury from June 2020 to May 2023. According to preoperative doctor-patient communication, 54 patients received DLR during the ORIF, while other 48 patients had ORIF only without DLR. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All the 102 patients were operated on successfully. Although the DLR group consumed significantly longer operative time [(110.0±12.7) min vs (104.2±12.0) min, P=0.020] and incision length [(8.5±2.3) cm vs (6.8±1.9) cm, P＜0.001] than the non-DLR group, the former proved significantly superior to the latter in terms of intraoperative X-ray fluoroscopy times [(8.0±2.0) vs (12.0±4.0) times, P＜0.001], hospital stay [(13.5±3.1) days vs (17.2±2.8) days, P＜0.001] and ambulation time [(14.7±4.2) days vs (20.5±4.7) days, P＜0.001]. The average follow-up time was of (19.5±3.8) months, and the DLR group resumed full weight-bearing activity significantly earlier than the non-DLR group [(78.6±16.0) days vs (92.0±20.5) days, P＜ 0.001]. In addition, the DLR group was also significantly better than the non-DLR group in terms of AOFAS score [(93.5±5.0) vs (91.4± 5.3), P=0.042], dorsal- plantar flexion ROM [(16.0±2.5)° vs (14.5±2.4)°, P=0.003] and inversion-eversion ROM [(17.5±2.7)° vs (16.0± 2.3)°, P=0.003] at the latest follow-up. As for imaging, the DLR group was further proved significantly superior to the non-DLR group regarding fracture reduction quality, talocrural angle (TCA), medial clear space (MCS) and tibiofibular clear space (TFCS) (P＜0.05). [Conclusion] Deltoid ligament repair does enhance the efficacy of ORIF and improve ankle joint function recovery for ankle fractures complicated with torn deltoid ligament.