踝部骨折伴三角韧带损伤的手术治疗△

Surgical treatment of ankle fractures accompanied with deltoid ligament tear

摘要:

［目的］ 比较不同手术方式对踝部骨折伴三角韧带损伤的治疗效果。［方法］ 回顾性分析 2018 年 1 月~2019 年 6 月接受手术治疗的合并下胫腓分离和三角韧带损伤的踝关节骨折患者 82 例，依据术前医患沟通结果，将患者分两组。其中，41 例开放复位骨折内固定同时行三角韧带修复 （修复组），另外 41 例仅行开放复位骨折内固定，未修复三角韧带 （未修复组）。 比较两组患者围手术期、随访和影像资料。［结果］82 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、术中失血量均显著大于未修复组（P<0.05）。所有患者均获随访 12~18 个月，平均（14.39±2.17）个月。修复组患者恢复完全负重时间显著早于未修复组（P<0.05）；随术后时间推移，两组患者 VAS 评分显著降低（P<0.05），而 AOFAS 评分和踝背伸-跖屈 ROM 和踝足内翻-外翻 ROM 均显著增加 （P<0.05）；相应时间点，修复组 VAS、AOFAS 评分显著优于未修复组 （P< 0.05），修复组踝足内翻-外翻 ROM 显著小于未修复组 （P<0.05）。影像方面，相应时间点两组间踝关节内侧关节间隙 （media clear space, MCS）、下胫腓关节间隙 （tibiofibular clear space, TFCS）、胫腓骨重叠 （tibiofibular overlap, TFO） 差异均无统计学意义 （P>0.05）。修复组骨折愈合显著早于未修复组 （P<0.05）。［结论］ 采用三角韧带加强修复术治疗有利于改善踝部骨折伴三角韧带损伤的临床效果。

Abstract:

[Objective] To compare clinical outcomes of open reduction and internal fixation (ORIF) of fractures with or without del- toid repair for ankle fractures accompanied with deltoid ligament tear. [Methods] A retrospective study was conducted on 82 patients who received surgical treatment for ankle fractures accompanied with the syndesmosis injury and deltoid ligament tear from January 2018 to June 2019. Based on the results of preoperative doctor-patient communication, the patients were divided into two groups. Among them, 41 patients underwent ORIF for fractures combined with deltoid ligment repaired, while the remaining 41 patients had ORIF only without del- toid ligament repaired. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 82 patients had operation completed successfully without serious complications. The repaired group was significantly greater than the unrepaired group in term of operation time, total incision length, and intraoperative blood loss (P＜0.05) . All patients were followed up for 12-18 months, with an average of (14.39±2.17) months. The patients in the repair group recovered to full weight bearing significantly earlier than those in the unrepaired group (P＜0.05) . The VAS score decreased significantly (P＜0.05) , while the AOFAS score and ankle dorsiflexion-plantar flexion ROM and ankle and foot varus-valgus ROM increased significantly over time postoperatively in both groups (P＜0.05) . However, the repaired group proved significantly superior to the unrepaired group at the corresponding time point in the VAS and AOFAS scores (P＜ 0.05) , despite of the fact that the repaired group had significantly less ankle foot varus-valgus ROM than the unrepaired group (P＜0.05) . Regarding to radiographic assessment, there was no statistically significant difference in MCS, TFCS and TFO between the two groups at the corresponding time points (P＞0.05) . The repaired group got fracture healing significantly earlier than the unrepaired group (P＜0.05) . [Conclusion] The deltoid ligament repairing is beneficial to improve the clinical outcomes of surgical treatment for ankle fracture accompanied with deltoid ligament tear.