三角韧带修复在踝关节骨折伴三角韧带损伤切开复位内固定治疗中的作用

doi:10.3760/cma.j.cn101202-20221105-00342

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摘要目的探讨三角韧带修复在踝关节骨折伴三角韧带损伤切开复位内固定（ORIF）治疗中的作用。方法回顾性队列研究。纳入2019年1月—2022年1月徐州仁慈医院足踝外科成功接受ORIF治疗的110例踝关节骨折伴三角韧带损伤患者的临床资料。其中,男85例、女25例,年龄23~63岁,骨折分型Weber-B型64例、Weber-C型46例。依据术中是否修复三角韧带分为ORIF组（单纯ORIF治疗,52例）和修复组（ORIF+三角韧带修复术,58例）。观察指标：（1）比较2组患者的性别、年龄、受伤类型、侧别、骨折分型等基线资料;（2）比较2组患者的手术时间、手术出血量、住院时间和并发症发生率等;（3）术后6个月随访时,比较2组不同Danis-Weber分型患者的近期疗效,包括骨折愈合时间、内踝间隙、距骨倾斜角和美国足踝外科协会（AOFAS）踝-后足评分,并比较踝关节功能优良率。结果 2组患者手术均顺利,术后切口均一期愈合。所有患者获随访6~24个月,其间均未出现踝关节不稳定和关节炎。（1）2组患者的基线资料比较差异均无统计学意义（P值均>0.05）。（2）修复组手术时间为（110.2±14.9）min,长于ORIF组的（98.6±12.1）min,差异有统计学意义（t=4.44,P<0.001）;2组手术出血量、住院时间和并发症发生率比较,差异均无统计学意义（P值均>0.05）。（3）修复组Weber-B型和Weber-C型患者的骨折愈合时间分别为（11.6±1.6）和（12.5±1.9）周,均短于ORIF组的（12.7±2.0）和（13.9±2.1）周,差异均有统计学意义（t=2.24、2.40,P值均<0.05）。组内比较显示,Weber-B型和Weber-C型患者术后6个月内踝间隙、距骨倾斜角均较术前下降,AOFAS踝-后足评分较术前明显升高,差异均有统计学意义（P值均<0.05）。ORIF组与修复组间比较：术前Weber-B型和Weber-C型患者内踝间隙、距骨倾斜角、AOFAS踝-后足评分差异均无统计学差异（P值均>0.05）;术后6个月修复组的内踝间隙、距骨倾斜角和复位不良率均小于或低于ORIF组,AOFAS踝-后足评分高于ORIF组,差异均有统计学意义（P值均<0.05）;术后6个月2组间Weber-B型患者内踝间隙、距骨倾斜角、AOFAS踝-后足评分及术后复位不良率差异均无统计学意义（P值均>0.05）,2组间Weber-C型患者差异均有统计学意义（P值均<0.05）。（4）2组间Weber-B型和Weber-C型患者踝关节功能恢复优良率比较,差异均无统计学意义（P值均>0.05）;总体比较,修复组患者术后6个月踝关节功能恢复优良率（91.4%,53/58）高于ORIF组（76.9%,40/52）,差异有统计学意义（χ²=4.40,P=0.036）。结论踝关节骨折伴三角韧带损伤患者ORIF术中进行三角韧带修复,能缩短骨折愈合时间,改善患者的踝关节功能,减少复位不良的发生,尤其对Weber-C型患者作用更显著。

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	王岩岩
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关键词 ：踝关节骨折, 三角韧带损伤, 切开内固定, 三角韧带修复术, 踝关节功能

Abstract：Objective To investigate the effect of deltoid ligament repair on the open reduction and internal fixation (ORIF) of ankle fracture with deltoid ligament injury. Methods Retrospective cohort study. The clinical data of 110 patients with ankle fractures and deltoid ligament injuries who were successfully treated with ORIF in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2019 to January 2022 were included in this study. The patients comprised 85 males and 25 females, aged 23-63 years. Among the patients, 64 had Weber-B type while 46 had Weber-C type of fractures. The patients were divided into two groups, the ORIF group (ORIF treatment, 52 cases) and repair group (ORIF + triangular ligament repair, 58 cases) in accordance with whether the triangular ligament was repaired during the operation. The outcome indexes were as follows. (1) Baseline data, such as gender, age, type of injury, affected side, and fracture type, were compared between the two groups. (2) Operation time, intraoperative blood loss, hospital stay length, and incidence of complications were compared between the two groups. (3) During the 6-month follow-up after surgery, the short-term outcomes of different Danis-Weber types, including fracture healing time, media clear space (MCS), talar inclination angle, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, were compared between the two groups. Excellent and good rates were calculated. Results Surgery was successful in both groups, and incisions healed within one stage after surgery. All the patients were followed-up for 6-24 months, and none of them developed ankle instability or arthritis during this period. (1) No significant differences were found in the baseline data between the two groups (all P values >0.05). (2) Operation time in the repair group was (110.2±14.9) min, which was longer than that in the ORIF group, i.e., (98.6±12.1) min. The difference was statistically significance (t=4.44, P<0.001). By contrast, the differences in intraoperative blood loss, hospital stay length, and the incidence rate of complications were not statistically significant (all P values >0.05). (3) The healing time of patients with Weber-B and Weber-C types of fractures in the repair group was (11.6±1.6) and (12.5±1.9) weeks, respectively, which were shorter than those in the ORIF group, i.e., (12.7±2.0) and (13.9±2.1) weeks, respectively. The differences were statistically significant (t=2.24, 2.40, all P values <0.05). Intragroup comparison showed that patients with Weber-B and Weber-C types of fractures exhibited decreased MCS and talar inclination angle and significantly increased AOFAS score 6 months after surgery compared with their values before surgery. The differences were statistically significant (all P values <0.05). Comparison between the ORIF and repair groups showed no statistically significant differences in MCS, talar inclination angle, AOFAS score before and after surgery, and postoperative poor reduction rate between patients with Weber-B and Weber-C types of fractures (all P values >0.05). Postoperative MCS, talar inclination angle, and poor reduction rate in the repair group were lower than those in the ORIF group, whereas AOFAS score was higher than that in the ORIF group. The differences were statistically significant (all P values <0.05). (4) No significant differences were recorded in the excellent and good rates of ankle joint function recovery between patients with Weber-B and Weber-C types of fractures (all P values >0.05). Overall, the excellent and good rates of ankle joint function recovery 6 months after surgery were higher in the repair group (91.4%, 53/58) than in the ORIF group (76.9%, 40/52). The difference was statistically significant (χ²=4.40, P=0.036). Conclusion Deltoid ligament repair during ORIF in patients with ankle fracture and deltoid ligament injury can significantly shorten fracture healing time, improve ankle joint function, and reduce the occurrence of mal-repositioning among patients with Weber-C type of fracture.

Key words： Ankle fracture Deltoid ligament injury Incision and internal fixation Repair of deltoid ligament Ankle function

收稿日期: 2022-11-05

通讯作者: 曹广超,Email：caoruiheng080305@163.com

引用本文:

王岩岩, 石荣剑, 俞光荣, 杨龙, 曹广超. 三角韧带修复在踝关节骨折伴三角韧带损伤切开复位内固定治疗中的作用[J]. 中华解剖与临床杂志, 2023, 28(7): 442-447.
Wang Yanyan, Shi Rongjian, Yu Guangrong, Yang Long, Cao Guangchao. Evaluation of the role of deltoid ligament repair in open internal fixation of ankle fracture with deltoid ligament injury. Chinese Journal of Anatomy and Clinics, 2023, 28(7): 442-447.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221105-00342 或 http://www.cjac.com.cn/CN/Y2023/V28/I7/442

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