两种方式修复三角韧带完全断裂的病例对照研究

Case-control study on two suturing methods for the repairing of complete rupture of the deltoid ligament

目的 ：通过回顾性对照研究比较钻孔经骨道不可吸收缝线缝合法与锚钉缝合法用于修复三角韧带完全断裂的手术疗效。方法：2009年1月至2013年1月采用钻孔经骨道不可吸收缝线缝合法和锚钉缝合法治疗58例踝关节骨折伴三角韧带完全断裂患者。采用钻孔经骨道不可吸收缝线缝合法治疗29例（A组）,男18例,女11例;平均年龄（39.76±11.81）岁;损伤按Lauge-Hansen分类,旋后外旋型Ⅳ度损伤12例,旋前外旋型Ⅲ度损伤5例、Ⅳ度损伤10例,旋前外展型Ⅲ度损伤2例。采用锚钉缝合法治疗29例（B组）,男14例,女15例;平均年龄（41.79±13.28）岁;损伤按照Lauge-Hansen分类,旋后外旋型Ⅳ度损伤9例,旋前外旋型Ⅲ度损伤6例、Ⅳ度损伤13例,旋前外展型Ⅲ度损伤1例。对所有骨折行切开复位内固定同时三角韧带行切开探查并手术修复以恢复踝关节内侧结构的稳定性。术后通过临床检查、影像学评估、美国足踝外科学会（AOFAS）踝-后足评分和视觉模拟评分（VAS）对临床结果进行评估,两组结果进行统计分析。结果：全部患者获随访,时间23~40个月,平均27.3个月,踝部骨折均愈合,骨折愈合时间10~17周,平均12.3周,未发生伤口并发症,无踝关节不稳定表现。两组术后AOFAS踝-后足评分（P=0.666）和视觉模拟评分（P=0.905）差异均无统计学意义。结论：钻孔经骨道不可吸收缝线缝合法治疗三角韧带完全断裂能够获得使用锚钉缝合同样优良的临床效果,避免了锚钉术后无法取出的弊端,具有减轻患者经济负担、节约社会医疗资源的优势。

Objective：To compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament. Methods：From January 2009 to January 2013,58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone（Group A）,including 18 males and 11 females,with an average age of（39.76±11.81） years old. According to the Lauge-Hansen classification,12 patients had supination external rotation（SER） injuries with Ⅳdegree,5 patients had pronation external rotation（PER） injuries whth Ⅲ degree,10 patients had PER injuries with Ⅳ degrss,and 2 patients had pronation abduction injuries with Ⅲ degree.There were 29 patients who received treatments with suturing using anchors（Group B）,including 14 males and 15 females,with an average age of（41.79±13.28） years old. According to the Lauge-Hansen classification,9 patients had SER injuries with Ⅳ degree,6 patients had PER injuries with Ⅲ degree,13 patients had PER injuries with Ⅳ degree,and 1 patient had pronation abduction injuries with Ⅲ degree. All the patients were treated with open reduction and internal fixation,as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination,imaging evaluation,American society for ankle surgery（AOFAS） ankle hindfoot score and visual analogue scale（VAS） were used to evaluate the clinical results after operation,and the results of the two groups were compared and analyzed statistically. Results：The follow up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union,and the mean healing time was 12.3 weeks（ranged,10 to 17 weeks）. There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS（P =0.666）and the VAS（P =0.905）.Conclusion：Treatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects,but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients,saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.