下胫腓前韧带加强修复治疗下胫腓联合不稳定

Treatment of Inferior Tibiofibular Instability with Anterior Inferior Tibiofibular Ligament Augmentation Repair

目的探讨下胫腓前韧带(anterior-inferior tibiofibular ligament,AITFL)修复加强技术治疗下胫腓联合不稳定的临床疗效。方法将2012年3月至2015年12月收治的155例合并下胫腓不稳定踝关节骨折患者,随机分成两组:a)AITFL修复加强治疗组,共77例,解剖修复AITFL,并用带线锚钉进行加强;b)螺钉治疗组,共78例,采用标准的下胫腓螺钉进行固定。对比观察两组的下胫腓复位不良率、下胫腓再分离、疼痛、Olerud-Molander踝关节功能评分,以及可见的医疗费用。结果两组患者均顺利愈合。术后3d内CT扫描显示,下胫腓复位不良率在AITFL组和螺钉组分别是2.6%(2/77)和23.1%(18/78)。后期AITFL组未发生下胫腓再增宽,螺钉组下胫腓再增宽率为8.9%(7/78)。术后3个月、6个月、12个月随访时,AITFL组Olerud和Molander踝关节骨折评分系统(Olerud-Molander ankle score,OMAS)功能评分均高于螺钉组,差异有统计学意义。AITFL组均无需二次手术,而螺钉组全部再取出,平均可见医疗费用AITFL组低于螺钉组。两组患者术后均无严重并发症发生。结论对后踝骨折固定后以及无后踝骨折但下胫腓后韧带未完全断裂的病例,对遗留的下胫腓不稳定,AITFL修复加强术可替代下胫腓螺钉,取得可靠的稳定性和满意的临床结果,并具有下胫腓复位质量高、操作简单、损伤小、功能恢复快和无需二次手术等优点。

Objective To explore the clinical effect of the anterior inferior tibiofibular ligament(AITFL)repair technique with augmentation in the treatment of inferior tibiofibular joint instability.Methods From March 2012 to December 2015,a total of 155 patients with ankle fractures with inferior tibiofibular instability treated in our hospital were randomly divided into two groups.There were 77 cases in AITFL repair with augmentation group treated with anatomical repair of AITFL and augmentation with an anchor.There were 78 patients in screws treatment group underwent standard screw fixation.The fraction defective of inferior tibiofibular joint reduction,inferior tibiofibular re-diastasis,ankle pain,Olerud-Molander ankle function score,and visible medical costs were observed.Results Fractrues in both groups successfully healed.CT scan showed fraction defective of inferior tibiofibular joint reduction were 2.6%(2/77)and 23.1%(18/78)in the AITFL group and screw group,respectively.In the later follow-up,no patients had significant re-diastasis of inferior tibiofibular joint in AITFL group,while re-diastasis happened in 8.9%(7/78)patients in screw group.At 3 months,6 months and 12 months after operation,the results of OMAS in AITFL group were higher than that in screw group,and the difference was statistically significant.No patients needed secondary surgery in AITFL group.But all patients underwent screw removal in screw group.The average visible medical expense of AITFL group was lower than that of the screw group.There was no serious complication in both groups.Conclusion To treat inferior tibiofibular joint instability in cases of posterior malleolus fracture fixation and incomplete rupture of the posterior tibiofibular ligament without posterior malleolus fracture,the technique of AITFL repair with augmentation could be used as a alternative to the inferior tibiofibular screws fixation,and it could be obtained a reliable stability and satisfactory clinical results.In addition,other advantages of the technique included the good tibiofibular joint reduction,simplicity of operation,less damage,quick function recovery and no need for secondary surgery.