旋后外旋型Ⅳ°踝关节骨折中内侧副韧带修复与下胫腓拉力螺钉固定的疗效

Deltoid ligament repair versus syndesmotic fixation in supination external rotation-4 ankle fractures

目的:对比分析旋后外旋型IV°(supination external rotation,SER-4型)踝关节骨折不同手术方式的疗效。方法:选取自2016年8月至2017年9月就诊于安徽医科大学第三附属医院的69例SER-4型踝关节骨折患者,分为2组,38例接受内侧三角韧带修复的患者为A组,其余31例行下胫腓螺钉固定的患者为B组。回顾性分析两组的手术时间、术中出血量、AOFAS评分、术后关节活动度、骨折愈合时间及术后并发症的发生率。结果:两组术中出血量、手术时间、骨折愈合时间差异无统计学意义(P>0.05),但A组术后1年的AOFAS评分及术后踝关节背伸-跖屈活动度则明显优于B组,差异有统计学意义(P<0.05)。所有行下胫腓拉力螺钉固定的患者术后均进行二次手术取出下胫腓拉力螺钉。A组术后并发症发生率较B组低,差异有统计学意义(P<0.05)。结论:内侧三角韧带修复在SER-4型骨折中可以牢固地恢复踝关节稳定性,在功能恢复方面优于下胫腓拉力螺钉固定,且可避免后续下胫腓拉力螺钉取出术所带来的风险。

Objective: To compare the outcome of patients with supination external rotation-4 ankle fracture in two different surgical methods. Methods: Sixty-nine patients with SER-4 ankle fracture in Third Affiliated Hospital of Anhui Medical University from Aug 2016 to Sep 2017 were selected and categorized into two groups: 38 patients deltoid ligament repair are group A, and other 31 patients with syndesmotic fixation are group B. Internal fixation operation time, fracture healing time, AOFAS Ankle Hind-foot Scale, blood loss, range of motion of ankle joint were retrospectively analysed. Results: There were no significant differences between the two groups in blood loss, the operation time and fracture healing time (P>0.05). Range of motion after operation and AOFAS Ankle Hindfoot Scale in group A is better than group B (P<0.05). All patients in the syndesmotic fixation group underwent a subsequent procedure for removal of the syndesmotic implant. There was significant difference between two group in the frequency of complications (P<0.05). Conclusion: Repairing the deltoid ligament can firmly restore ankle stability in SER-4 ankle fracture, and is superior to syndesmotic fixation in functional recovery, and can avoid inherits surgical risks that occur during a subsequent operation for removal of the syndesmotic implant.