手术治疗踝关节骨折伴三角韧带损伤的疗效观察

发布时间：2018-04-12 18:51

本文选题：踝关节骨折 + 三角韧带损伤　；参考：《中国修复重建外科杂志》2015年04期

【摘要】：目的探讨手术治疗踝关节骨折伴三角韧带损伤的疗效。方法 2010年1月-2013年1月,收治11例踝关节骨折伴三角韧带损伤患者。其中男7例,女4例;年龄18~72岁,平均38.2岁。受伤至手术时间为6 h~7 d,平均4 d。踝关节骨折根据Lauge-Hansen分型标准:旋前-外旋型5例,旋后-外旋型4例,旋前-外展型2例。踝关节彩色多普勒超声及MRI检查证实三角韧带断裂。麻醉后行外翻应力试验、距骨外翻倾斜试验和前抽屉试验均为阳性。踝关节骨折行切开复位内固定,探查并修复三角韧带。结果术后切口均Ⅰ期愈合,无感染等手术相关并发症发生。患者均获随访,随访时间12~18个月,平均13.3个月。X线片复查示,骨折均解剖复位,内固定物位置满意,踝关节各骨对应关系无异常,下胫腓联合关系正常;骨折均愈合,愈合时间6~8周,平均7.6周。术后3~6个月复查踝关节MRI示三角韧带形态正常。按美国足踝外科协会(AOFAS)评分:获优6例,良3例,可1例,差1例,优良率81.8%。结论对于踝关节骨折伴三角韧带损伤,切开复位内固定骨折同时修补三角韧带,可最大程度恢复踝关节内侧稳定结构。
[Abstract]:Objective to investigate the effect of surgical treatment of ankle fracture with deltoid ligament injury.Methods from January 2010 to January 2013, 11 cases of ankle fracture with deltoid ligament injury were treated.There were 7 males and 4 females with an average age of 38.2 years (1872 years).The time from injury to operation was 6 hours and 7 days, with an average of 4 days.According to Lauge-Hansen classification criteria, 5 cases of pronation and external rotation type, 4 cases of pronation and external rotation type, 2 cases of pronation and abduction type.Ankle color Doppler ultrasound and MRI confirmed the rupture of the triangular ligament.After anesthesia, valgus stress test, talus valgus tilt test and anterior drawer test were all positive.Ankle fractures were treated with open reduction and internal fixation, and deltoid ligament was explored and repaired.Results all the incisions healed in one stage and no infection occurred.All the patients were followed up for 12 ~ 18 months with an average of 13.3 months. X-ray examination showed that the fractures were all anatomically reduced, the internal fixation was satisfactory, the corresponding relationship of the ankle bones was not abnormal, the relationship between the lower tibiofibular syndesmosis was normal, the fractures were all healed.The healing time was 6 weeks, 8 weeks, with an average of 7.6 weeks.After 3 ~ 6 months, MRI of ankle showed normal shape of triangular ligament.According to AOFASA score: 6 cases were excellent, 3 cases were good, 1 case was fair, 1 case was poor, the excellent and good rate was 81.8%.Conclusion for ankle fracture with deltoid ligament injury, the medial stable structure of ankle joint can be recovered as much as possible by open reduction and internal fixation of the fracture and repair of the triangular ligament.
【作者单位】：上海市静安区中心医院;复旦大学附属华山医院静安分院骨科;
【基金】：上海市静安区卫生计生系统第3批“十百千”卫生人才培养资助项目(JWRC2014Q03)~~
【分类号】：R687.3

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