摘要
目的探讨合并三角韧带损伤的重度旋前-外旋踝关节骨折手术方法和治疗效果。方法2005年7月-2007年4月,采用切开复位内固定,结合带线锚钉修补治疗17例合并三角韧带损伤的旋前-外旋踝关节骨折。男13例,女4例;年龄21～56岁,平均36.5岁。均为闭合性损伤,不伴软组织缺损,关节活动受限。术前X线片及CT检查均可见外踝、后踝骨折,有明显外移的距骨,不伴内踝骨折。根据Lauge-Hansen分型均为旋前-外旋型Ⅳ度损伤,根据Danis-Weber分型均为C型。受伤至手术时间4～7d,平均5.6d。结果术后患者伤口均Ⅰ期愈合。17例均获随访,随访时间11～24个月,平均15.6个月。X线片示17例骨折均达骨性愈合,愈合时间11～16周,平均14.8周。按改良Baird-Jackson评分系统评价:优5例,良9例,可2例,差1例,优良率82.4%。无手术相关并发症发生。X线片测得术后内踝间隙为(3.16±0.37)mm,与术前(4.87±0.43)mm比较差异有统计学意义(P<0.01);术后患侧重力应力位下内踝间隙为(3.55±0.44)mm,与健侧(3.47±0.43)mm比较差异无统计学意义(P>0.05)。结论治疗合并三角韧带损伤的Ⅳ度旋前-外旋踝关节骨折,在骨折切开复位内固定同时应充分重视修复重建内侧韧带结构。
Objective To investigate the surgical techniques and the clinical outcomes of treating severe pronation-external rotation ankle fractures combined with deltoid ligament injuries.Methods Between July 2005 and April 2007, 17 patients with grade-IV pronation-external rotation ankle fractures combined with deltoid ligament injuries were treated by open reduction and internal xation with ligament repair by using suture anchors.There were 13 males and 4 females with an average age of 36.5 years（21-56 years）.All cases were closed injuries with limitation of motion after initial physical examination.The X-ray and CT showed that all patients were characterized with lateral and posterior malleolus fractures and signi cant lateral shift of talus, but without medial malleous fracture before operation.All fractures were classi ed into grade-IV pronation-external rotation or type C according to Lauge-Hansen criterion and Danis-Weber standard respectively.The disease course was from 4 days to 7 days with an average of 5.6 days.Results All incisions healed by rst intention.Seventeen patients were followed up 11-24 months（mean 15.6 months）.The X-ray lms showed that all patients achieved bony healing.The healing time was 11-16 weeks（mean 14.8 weeks）.According to the Baird-Jackson＇s scoring system, the results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 82.4%.No operation complication occurred.Medial clear space was signi cantly decreased postoperatively compared with that before operation（3.16 ± 0.37） mm vs.（4.87 ± 0.43） mm（P 〈 0.01）.In gravity stress radiographs, there was no signi cant di erence in medial clear space between collateral ankle and injured ankle after operation（3.47 ± 0.43） mm vs.（3.55 ± 0.44） mm（P 〉 0.05）.Conclusion It is emphasized that full attention should be given to reconstruction of medial ligament structures as well as open reduction and internal xation in treating grade-IV pronation-external rotation ankle fractures combined with deltoid ligament injuries.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第5期577-580,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
锚钉
三角韧带
踝关节
骨折
Anchor Deltoid ligament Ankle joint Fracture
