急性踝关节三角韧带损伤的诊疗进展

Diagnosis and treatment progress of the acute injury of the deltoid ligament

踝关节三角韧带损伤约占所有踝关节损伤的15％左右[1-3]，其中内侧三角韧带损伤率远远低于外侧副韧带损伤率，约6%左右[4,47]。据统计，在美国，每天大约有2700余人发生踝关节损伤，其中伴有三角韧带损伤占有5%左右[5]。根据 Lauge-Hanson 分型，踝关节三角韧带主要损伤机制分为旋后外旋型、旋前外展型以及旋前外旋型，在3种损伤方式中又以旋后外旋型损伤为主，约占踝关节损伤的10%[6-8]。何河北等[9]指出：修复三角韧带组术后 Mazur 评分较不修复组明显增高，同时，修复组术后踝关节的稳定性也更好。同样，也有学者在对踝关节骨折伴有内侧三角韧带损伤的患者进行手术时发现，修复三角韧带在一定程度上决定了患者术后踝关节的稳定性[10-11]。因此，在急性踝关节三角韧带损伤时，建议行韧带的修复或者韧带重建。

The deltoid ligaments of ankle are the main stable structures on maintaining the mechanical structures of medial ankle, which play an important role in keeping ankle stability by limiting excessive valgus and external rotation of ankle. The deltoid ligaments of ankle are divided into the deep and superifcial layers. Superifcial layers mainly limit outreach and slope of the talus, and meanwhile, deep layers play a crucial role in the prevention of talus pronation. Deltoid ligament injuries always happen with the fracture of the extramalleolus and injury of inferior tibioifbular syndesmosis. At present, there is no standard about the diagnosis and treatment of acute deltoid ligament injury. Stress X-ray of ankle, B ultrasound, MRI and arthroscopy of ankle can be used as the main basis of diagnosis, but the diagnosis and treatment of acute deltoid ligament injury remains a worldwide problem. The views inside and outside the country are different for the treatment of acute deltoid ligament injury. Domestic scholars suggest to repair with anchor suture, but, foreign scholars support ligament reconstruction surgery. During the treatment, many doctors attach great importance to the open reduction and internal ifxation of the fracture of the medial malleolar and lateral malleolus, and ignore the repairing of the medial deltoid ligament, which eventually leads to continuous postoperative instability of the ankle and poor effects. In this paper, we are to discuss the diagnosis and treatment progress of the acute injury of the deltoid ligament.