锚钉修复三角韧带结合内固定治疗旋前外旋Ⅳ度踝关节骨折

Internal fixation combined with anchoring nail for deltoid ligament injuries in the treatment of grade Ⅳ pronation-external rotation ankle fractures

目的探讨应用锚钉修复三角韧带损伤结合钢板螺钉内固定治疗旋前外旋Ⅳ度踝关节骨折的疗效。方法 2009年8月~2011年10月,对26例旋前外旋型Ⅳ度踝关节骨折行切开复位内固定,并植入锚钉修复三角韧带深层和浅层,恢复内、外侧结构的稳定性。术后观察骨折愈合及患者踝关节功能恢复情况。结果 26例随访6~30个月,平均16个月。所有骨折均愈合,时间10~16周,平均12周。1例未固定下胫腓联合的患者,负重后逐渐出现踝穴增宽、距骨外移导致创伤性关节炎而疼痛。采用Mazur踝关节症状与功能评分评定疗效:优15例,良8例,可2例,差1例,优良率为88.5%。无感染、骨折不愈合、锚钉松动等发生。结论应重建旋前外旋型踝关节骨折中三角韧带的连续性及下胫腓联合的稳定性,锚钉具有创伤小、对踝关节生理影响小等特点,是修复三角韧带损伤的有效方法。

Objective To explore the curative effects of internal fixation and anchoring nail in the treatment of gradeⅣ pronation-external rotation ankle fractures complicated with dehoid ligament injures. Methods From Aug. 2009 to Oct. 2011,26 patients with grade Ⅳ pronation-external rotation ankle fractures complicated with dehoid liga,nent injuries were treated with open reduction and internal fixation. The dehoid ligament was reconstructed with anchoring nail to restore the medial and lateral stability of ankle joint. Bone healing and the restoration of ankle joint function ＇after operation were observed. Results The 26 eases were followed up for 6 to 30 months（ 16 months on average）. All cases had osseous union after 10 to 16（ average, 12） weeks. One case without fixation of the tibiofibular syndesmosis had mild postoperative pain because of widened syndesmosis and traumatic arthritis. All patients were evaluated with modified Mazur scoring system. The clinical effectiveness was excellent in 15,good in 8,fair in 2 and poor in 1. The excellent and good rate was 88.5%. No infection, no fracture ununion or anchoring nail loosening occurred. Conclusion For pronation-external rotation ankle fractures, the continuity of the deltoid ligament and stablility of tibiofibular syndesmosis should be restored. Anchoring nail is effective in the repair of deltoid ligament injury for the advantages of minimally-invasiveness, little influence on the function of ankle joint,and reliable effect.