手术治疗三角韧带完全断裂的旋前外旋型踝关节骨折

Surgical Treatment of Supine-external Rotation Ankle Fractures with Complete Rupture of the Deltoid Ligament

目的探讨三角韧带完全断裂的旋前外旋型踝关节骨折手术治疗方法和临床疗效。方法对30例三角韧带完全断裂的旋前外旋型踝关节骨折患者在骨折复位固定的同时修复三角韧带,其中男16例,女14例,年龄18~64岁。交通伤15例,扭伤12例,重物压伤3例。损伤均为旋前外旋型,按照Lauge-Hansen分类,Ⅲ度12例,Ⅳ度18例。采用美国足踝外科学会（American orthopaedic foot and ankle society,AOFAS）踝-后足评分和视觉模拟评分（visual analogue scale,VAS）对临床结果进行评估。结果 30例患者均获随访,时间12~18个月,平均13.5个月。骨折均愈合,愈合时间10~16周,平均12.8周。末次随访时AOFAS踝-后足评分为84~99分（平均94.6分）,VAS评分为0~6分,平均1.3分,无踝关节不稳定表现。结论对旋前外旋型踝关节骨折合并三角韧带完全断裂的患者,需要合理临床评估后选择治疗方案,根据断裂部位选择适当的手术缝合方法,可以取得较满意的效果。

Objective To investigate the surgical procedure and clinical outcome of treatment for supine-external rotation ankle fractures associated with completer rupture of the deltoid ligament. Methods We treated 30 cases of supine-external rotation ankle fracture associated with complete rupture of the deltoid ligament rupture. Reduction and fixation of the fracture and repair of the ruptured ligament were conducted simultaneously for all patients. American Orthopaedic Foot and Ankle Society（ AOFAS） ankle-hindfoot scores and visual analogue scale（ VAS） were used for outcome measurement. Results Thirty patients were followed up for 12 to 18 months,with an average of 13. 5 months. The time for bone union was 12. 8weeks（ range,10 to 16 weeks）. The AOFAS ankle-hindfoot score at the last follow-up was 94. 6 points（ range,84 to 99 points）. The VAS score was 1. 3 points（ range,0 to 6 points）. There was no ankle instability. Conclusion To achieve satisfactory outcomes for patients with supine-external rotation ankle fractures associated with complete rupture of the dehoid ligament,a proper surgical procedure should be chosen according to reasonable preop-erative evaluation and a proper suture technique according to the rupture site of the deltoid ligament.