踝关节三角韧带断裂的锚钉修复技术

Targeted suture anchor repair technique for deltoid ligament rupture

目的总结踝关节三角韧带断裂的特点，探讨依据断裂部位的针对性锚钉修复技术的可行性及近期临床疗效。方法收集2011年5月至2014年10月踝关节三角韧带完全断裂19例患者资料，其中男17例，女2例，年龄15-60岁，平均（34．15±1．23）岁；依Lauge-Hansen分型：旋前外旋型Ⅳ度损伤7例（其中3例Maisonnuve骨折），旋前外展型Ⅲ度损伤1例，Ⅳ度损伤1例；旋后外旋型Ⅳ度损伤10例；依据AO／OTA分型：43B型9例，43C型10例。根据三角韧带断裂部位，分别实施针对性锚钉修复手术，术后穿戴护踝早期功能锻炼，末次随访依据美国矫形足踝协会（American Orthopedic Foot and Ankle Societiy，AOFAS）踝．后足评分及视觉模拟评分（visual analogue scale，VAS）进行功能评定。结果19例均获得随访，随访时间24-48个月，平均（30．42±5．11）个月。距骨止点处断裂14例（73．7％，14／19），行距骨侧双锚钉植入残端锁边缝合修复；中间部分断裂4例（21．1％，4／19），行距骨侧双锚钉植入、内踝穿骨道修复；内踝止点处撕脱1例（5．3％，1／19），行内踝侧单锚钉植入残端锁边缝合修复。末次随访时，AOFAS评分70-96分，平均90．53分，优16例，良2例，可1例，优良率为94．7％；VAS评分0～2分，平均0．42分。至末次随访，19例中2例出现创伤性关节炎；无一例内踝间隙增宽。结论依据三角韧带断裂的不同部位采用针对性锚钉修复技术，有利于术后早期功能锻炼，功能恢复更快，并发症少。

Objective To summarize the characteristics of deltoid ligament rupture and explore the feasibility and short- term clinical outcomes of targeted suture anchor repair technique according to the rupture site. Methods From May 2011 to October 2014, 19 cases of complete deltoid ligament rupture （17 males and 2 females） were recruited in this study, with an average age of 34.15± 1.23 years （ranged from 15 to 60 years）. According to Lauge- Hansen classification, there were 7 cases of pronation external rotation grade IV injury, including 3 cases of Maisonnuve fracture; 1 case of pronation abduction type Ⅲ degree injury, 1 case of pronation abduction grade IV injury; and 10 cases of supination external rotation grade IV injury. According to AO / OTA classification, there were 9 cases of 43B type injury and 10 cases of 43C type injury. According to the rupture site of deltoid ligament, the targeted suture anchor repair surgery was operated respectively. Early mobilization with the help of hinged ankle brace was encouraged. The evaluation at last follow-up was based on the American Orthopedic and Ankle Association （AOFAS） criteria of ankle and hindfoot, and the visual analogue scale （VAS） scoring system. Results Nineteen patients were all followed up for 24 to 48 months, with an average of 30.42±5.11 months. Fourteen cases （73.7%, 14/19） with talus end avulsion were treated by double suture anchor in the talus, with continuous locking suture of the avulsed end. Four cases （21.1%, 4/19） with middle part rupture were treated by double suture anchor in the talus, with the sutures crossing three bone tunnels at the medial malleolus. One case （5.3%, 1/19） with medial malleolus end avulsion was treated by single suture anchor at the medial malleolus, with continuous locking suture of the avulsed end. At the last follow-up, the AOFAS score was ranged from 70 points to 96 points, with an average of 90.53 points, and excellent in 16 cases, good in 2 cases, fair in 1 case, excellent and good rate was 94.7%. The VAS score was ranged from 0 to 2 points, with an average of 0.42 point. No wide medical clear space was detected. But traumatic arthritis was happened in 2 patients. Conclusion The targeted suture anchor repair technique according to the rupture site was a save technique in treating deltoid ligament rupture, which is conducive to early postoperative functional exercise, with excellent short-term clinical outcomes and few complications.