摘要【目的】探讨缝合锚钉在踝关节骨折合并三角韧带完全断裂修复中的临床应用价值。【方法】回顾性分析本院2015年1月至2020年1月收治的69例踝关节骨折合并三角韧带完全断裂患者的临床资料。按患者手术中是否应用缝合锚钉修复三角韧带深层,将其分为修复组(36例)和未修复组(33例)。对比两组术后1个月、术后6个月内侧间隙(MCS)、美国足踝外科协会踝-后足评分(AOFAS)及疼痛视觉模拟评分(VAS)变化以及术后6个月踝关节活动度,评价两组临床疗效与安全性。【结果】两组术后6个月AOFAS评分均较术后1个月升高,VAS评分均较术后1个月下降,且修复组术后1个月、术后6个月MCS、VAS评分均低于未修复组,AOFAS评分高于未修复组;术后6个月,修复组踝关节趾屈、背伸角度均大于未修复组,临床优良率高于未修复组(86.11% vs 69.70%),其差异均有统计学意义(均P<0.05)。修复组术后并发症发生率为2.78%,低于未修复组的21.21%,差异有统计学意义(P<0.05)。【结论】缝合锚钉修复三角韧带深层能够促进踝关节骨折合并三角韧带完全撕裂患者术后踝关节功能恢复、减轻术后疼痛,降低术后复位不良等并发症风险,具有较好的临床应用价值。
Abstract：【Objective】To investigate the clinical value of suture anchor in the repair of ankle fracture complicated with complete rupture of deltoid ligament. 【Methods】The clinical data of 69 patients with ankle fracture combined with complete rupture of deltoid ligament in our hospital from January 2015 to January 2020 were retrospectively analyzed. The patients were divided into the repair group (n=36) and the non-repair group (n=33) according to whether suture anchor was used to repair the deep deltoid ligament. The changes of medial space (MCS), American Association of foot and ankle surgeon's ankle-hindfoot score (AOFAS) and visual analogue scale (VAS) at 1 month and 6 months after operation, and the range of motion of ankle joint at 6 months after operation were compared between the two groups to evaluate the clinical efficacy and safety of the two groups. 【Results】The AOFAS scores of the two groups at 6 months after operation were higher than those at 1 month after operation, while the VAS scores were lower than those at 1 month after operation. The MCS and VAS scores of the repair group at 1 month and 6 months after operation were lower than those of the non-repair group, and the AOFAS scores were higher than those of the non-repair group. At 6 months after operation, the toe flexion and back extension angles of the repair group were higher than those of the non-repair group, and the clinical excellent and good rate was higher than that of the non-repair group (86.11% vs 69.70%). The differences were statistically significant (all P<0.05). The incidence of postoperative complications in the repair group was 2.78%, which was lower than 21.21% in the non-repair group (P<0.05). 【Conclusion】Suture anchor repair of deep deltoid ligament can promote ankle function recovery, reduce postoperative pain, and reduce the risk of postoperative complications such as poor reduction in patients with ankle fracture combined with complete tear of deltoid ligament.
陈强, 刘鹏, 蔡飞, 白军军, 魏建江, 赵建武. 缝合锚钉在踝关节骨折合并三角韧带完全断裂修复中的应用[J]. 医学临床研究, 2021, 38(1): 84-87.
CHEN Qiang, LIU Peng, CAI Fei, et al. Application of Suture Anchor in the Repair of Ankle Fracture complicated with Complete Rupture of Deltoid Ligament. JOURNAL OF CLINICAL RESEARCH, 2021, 38(1): 84-87.
[1] 秦大山, 徐彬, 黄万强. 踝关节骨折三角韧带损伤的诊断与治疗进展[J].世界最新医学信息文摘 (电子版), 2018, 18(16): 102-104. [2] Woo SH, Bae SY, Chung H J.Short-term results of a ruptured deltoid ligament repair during an acute ankle fracture fixation[J].Foot Ankle Int,2018, 39(1): 35-45. [3] Dabash S, Elabd A, Potter E, et al. Adding deltoid ligament repair in ankle fracture treatment: Is it necessary A systematic review[J].Foot Ankle Surg,2019, 25(6): 714-720. [4] 李恺鲁, 潘世安, 陈文龙. 带线锚钉修复联合解剖钢板内固定治疗踝关节骨折合并三角韧带断裂的临床疗效[J].基层医学论坛, 2020, 24(23): 3268-3270. [5] 张付民, 罗政, 魏世隽. 踝关节骨折合并三角韧带撕裂术中三角韧带不同修复方式的效果比较[J].中国骨与关节损伤杂志, 2020, 35(8): 800-803. [6] Zhao HM.Surgical treatment of ankle fracture with or without deltoid ligament repair: a comparative study[J].BMC Musculoskelet disord,2017, 18(1): 543. [7] 徐贤, 刘林, 李聪, 等. 踝关节骨折合并三角韧带损伤的手术疗效分析[J].浙江临床医学, 2018, 20(4): 631-633. [8] Stevens NM, Wasterlain AS, Konda SR.Case report: irreducible ankle fracture with posterior tibialis tendon and retinaculum, deltoid ligament, and anteromedial joint capsule entrapment[J].J Foot Ankle Surg,2017, 56(4): 889-893. [9] Mococain P, Bejarano-Pineda L, Glisson R, et al. Biomechanical effect on joint stability of including deltoid ligament repair in an ankle fracture soft tissue injury model with deltoid and syndesmotic disruption[J].Foot Ankle Int,2020, 41(9): 1158-1164. [10] 李磊, 阳波, 刘东, 等. 踝关节骨折合并三角韧带断裂术中修复与不修复三角韧带的疗效比较[J].中国骨与关节损伤杂志, 2018, 33(4): 430-432. [11] Li T, Sun X, Li Y, et al. Clinical study of ankle fracture combined with deltoid ligament injury: repair or not? A retrospective, comparative study[J].J Foot Ankle Surg,2020, 59(4): 648-652. [12] Salameh M, Alhammoud A, Alkhatib N, et al. Outcome of primary deltoid ligament repair in acute ankle fractures: a meta-analysis of comparative studies[J].Int Orthop,2020, 44(2): 341-347. [13] 包毅敏. 带线锚钉内固定治疗踝关节骨折合并三角韧带损伤临床研究[J].实用骨科杂志, 2017, 23(4): 371-374. [14] Gougoulias N, Sakellariou A.When is a simple fracture of the lateral malleolus not so simple? How to assess stability, which ones to fix and the role of the deltoid ligament[J].Bone Joint J,2017, 99(7): 851-855. [15] Wang X, Zhang C, Yin J, et al. Treatment of medial malleolus or pure deltoid ligament injury in patients with supination‐external rotation type Ⅳ ankle Fractures[J].Orthop Surg,2017, 9(1): 42-48. [16] 张明珠. 踝关节骨折伴三角韧带完全断裂的手术治疗[J].中华解剖与临床杂志, 2019, 24(2): 118-122. [17] 程其远, 干阜生. 踝关节骨折并三角韧带深层或全层断裂两种治疗方法比较[J].中国临床研究, 2017, 30(1): 64-66. [18] Massri-Pugin J, Lubberts B, Vopat BG, et al. Role of the deltoid ligament in syndesmotic instability[J].Foot Ankle Int,2018, 39(5): 598-603.
2021, Vol. 38 
