切开复位内固定踝关节骨折：联合带线锚钉修复三角韧带损伤的意义

Open reduction fixation for treating ankle joint fractures: a wire anchor in the repair of triangular ligament injury

背景:踝关节骨折合并急性三角韧带损伤是一种常见的损伤类型,容易对踝关节解剖结构产生影响,导致关节不稳定,治疗不当极易导致多种并发症的出现。对于受损的三角韧带,是否需要修复临床存在争议。目的:探讨带线锚钉修复三角韧带损伤在踝关节骨折内固定治疗中的作用。方法:回顾性分析淄博市第七人民医院骨科2013年5月至2014年5月收治的36例踝关节骨折合并三角韧带损伤患者的临床资料,予以切开复位钢板置入内固定踝关节骨折联合带线锚钉修复三角韧带损伤。治疗后随访12个月,应用美国足踝外科学会(AOFAS)的踝与后足功能评分评估患者踝关节功能恢复情况;治疗前后对患者进行重力应力X射线检查,测量患侧内踝间隙;并观察修复术后不良事件发生情况。结果与结论:治疗后3,6,12个月分别对患者进行随访,可见患者的踝关节AOFAS评分较治疗前增高,其中治疗后12个月的AOFAS评分显著高于治疗前(P<0.05)。重力应力X射线检查结果显示,治疗后12个月患者患侧内踝间隙显著小于治疗前(P<0.05)。术中患者均未出现神经及血管损伤等,切口均为一期愈合,无感染出现。未出现内固定断裂、松动等不良事件,但患者三角韧带损伤修复后出现部分踝关节功能受限。结果证实,对于踝关节骨折合并三角韧带损伤患者实施切开复位内固定联合带线锚钉修复三角韧带可以获得良好的效果。

BACKGROUND： Ankle joint fracture combined with triangular ligament injury is a common type of injury, and is easy to have an impact on the anatomy of the ankle joint, leading to the occurrence of joint instability; the treatment is extremely easy to lead to a variety of complications. For injured triangular ligament, it is controversial whether it is necessary to repair in the clinic. OBJECTIVE： To investigate the effect of a wire anchor for repairing triangular ligament in ankle joint fracture fixation. METHODS： The clinical data of 36 cases of ankle fractures combined with triangular ligament injury, who were treated in the Department of Orthopedics of the Seventh People＇s Hospital of Zibo City from May 2013 to May 2014, were retrospectively analyzed. The ankle fractures combined with triangular ligament injury were treated with open reduction plate fixation. The patients were followed up for 12 months. The recovery of ankle joint function was evaluated with the American Orthopaedic Foot Ankle Society（AOFAS） ankle and foot function score. Gravity stress X-ray examination was performed before and after treatment. Space of medial malleolus was measured. Adverse events were observed. RESULTS AND CONCLUSION： The patients were followed up 3, 6 and 12 months after treatment. AOFAS score of the ankle joint was increased and significantly higher at 12 months than that before surgery（P〈0.05）. Gravity stress X-ray examination revealed that the space of medial malleolus of the affected side was smaller at 12 months than that before treatment（P〈0.05）. No injuries to nerves and blood vessels were found during surgery, and the incision was healed in the first stage, and no infection was observed. Adverse events such as fixator breakage and loosening were not visible. However, partial function of the ankle joint was limited after repair in triangular ligament injury. Results confirmed that open reduction and internal fixation combined with a wire anchor obtained good effects in the repair of ankle joint fracture with triangular ligament injury.