踝关节骨折伴三角韧带损伤修复与不修复的疗效比较

发布时间：2018-06-06 08:55

本文选题：踝关节骨折 + 三角韧带　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:通过对踝关节骨折伴有三角韧带损伤患者的随访研究,比较三角韧带手术修复与不修复的临床治疗效果,为三角韧带损伤的临床治疗提供参考。方法:纳入2014年7月至2015年7月无锡市中医医院创伤骨科收治的踝关节骨折伴有三角韧带损伤患者72例,分为实验组和对照组,两组踝关节骨折均行切开复位内固定,实验组36例患者手术修复三角韧带,对照组36例患者不修复。术后采用门诊复查或电话回访的方式进行跟踪随访,比较两组术中出血量、手术时间、AOFAS踝-后足评分、术后并发症、住院时间、术后踝关节疼痛评分、内踝间隙,计量资料以均数±标准差表示并采用t检验,率的比较及计数资料采用χ2检验,以P0.05为差异有统计学意义。结果:(1)在研究期限内共随访72例患者,均为闭合性损伤,未合并其他部位骨折。受伤至手术时间3-7 d,平均4.3 d。其中实验组男20例,占56%,女16例,占44%,左侧踝关节20例,占56%,右侧踝关节16例,占44%,对照组男19例,占53%,女17例,占47%,左侧踝关节18例,占50%,右侧踝关节18例,占50%。实验组平均年龄(38.16±13.55)岁,对照组平均年龄(38.68±13.24)岁。(2)实验组与对照组患者性别、年龄、损伤部位、术中出血量、术后并发症均无统计学意义,实验组平均手术时间为(113.56± 14.68)min,对照组平均手术时间为(101.32±13.96)min,用χ2检验得出P=0.042,P0.05,实验组手术时间明显长于对照组;术后3个月踝关节功能优良率实验组为91.7%,对照组为83.3%,术后3个月实验组踝关节的优良率明显高于对照组(P0.05);实验组平均住院时间为(16.26±3.62)d,对照组平均住院时间为(17.41±4.02)d,用χ2检验得出P=0.636,P0.05,实验组住院时间与对照组无明显差异;实验组和对照组术后3个月踝关节疼痛评分分别为(1.06±0.25)分和(2.68±0.32)分,都明显低于术前(6.28±0.82)分和(6.20±0.60)分,同时实验组与对照组组间对比,术前疼痛评分P0.05,无统计学意义,术后P0.05,实验组疗效要好于对照组;实验组和对照组术后3个月内踝间隙分别是(2.06±0.25)mm 和(2.68±0.32)mm,都明显低于术前(5.12±1.20)mm 和(5.34±1.35)mm,同时术前两组组间对比P0.05,无统计学意义,术后P0.05,实验组内踝间隙要小于对照组。结论:(1)临床上要在详细的病史、临床症状及相关体征的基础上进行有目的地影像学检查,以提高诊断的准确率。(2)踝关节骨折伴有三角韧带损伤的患者,修复三角韧带可更有效的促进患者康复,促进患者踝关节功能的恢复。(3)对于三角韧带深层损伤的患者,本文建议首选手术以恢复三角韧带的连续性与完整性。
[Abstract]:Objective: to compare the clinical effects of surgical repair and non-repair of triangular ligament in patients with ankle fracture associated with triangular ligament injury, so as to provide reference for clinical treatment of triangular ligament injury. Methods: from July 2014 to July 2015, 72 patients with ankle fracture associated with deltoid ligament injury in Department of Orthopedics, Wuxi traditional Chinese Medicine Hospital, were divided into experimental group and control group. The two groups were treated with open reduction and internal fixation. The experimental group (36 cases) underwent surgery to repair the triangular ligament, while the control group (36 cases) did not. The blood loss, operative time, postoperative complications, hospital stay, ankle pain score and medial ankle space were compared between the two groups by means of outpatient reexamination or telephone follow-up, and compared with those of the two groups in terms of intraoperative bleeding, AOFAS ankle-hind foot score, postoperative complications, hospitalization time, postoperative ankle pain score, and medial malleolus space. The measurement data were expressed as mean 卤standard deviation and t test was used, and 蠂 2 test was used to compare the rate and count data. The difference was statistically significant with P0.05. Results A total of 72 patients were followed up during the study period, all of whom were closed injuries without fracture of other parts. The time from injury to operation was 3 to 7 days, with an average of 4.3 days. There were 20 males in the experimental group (56%), 16 cases in the female (44 cases), 20 cases in the left ankle joint (20 cases), 56 cases in the left ankle joint, 16 cases in the right ankle joint (44 cases), 19 cases in the control group (19 cases), 53 cases (53 cases), 17 cases (4747) in the control group, 18 cases in the left ankle joint (50%), 18 cases in the right ankle joint (50%), and 50 cases in the right ankle joint. The average age of the experimental group was 38.16 卤13.55 years old, and that of the control group was 38.68 卤13.24 years old. The mean operation time was 113.56 卤14.68 min in the experimental group and 101.32 卤13.96 min in the control group. The excellent and good rate of ankle joint function was 91.7 in the experimental group and 83.3 in the control group 3 months after operation, the excellent and good rate of the ankle joint in the experimental group was significantly higher than that in the control group 3 months after operation, the average hospitalization time of the experimental group was 16.26 卤3.62 days, the average hospitalization time of the control group was 17.41 卤4.02 days, 蠂 2 was used. The results showed that there was no significant difference in the length of hospitalization between the experimental group and the control group. The scores of ankle joint pain in experimental group and control group were 1.06 卤0.25 and 2.68 卤0.32 respectively, which were significantly lower than those before operation (6.28 卤0.82) and 6.20 卤0.60 (P < 0.05). After operation, the curative effect of the experimental group was better than that of the control group, the malleolus space of the experimental group and the control group were 2.06 卤0.25)mm and 2.68 卤0.32 mm respectively within 3 months after operation, which were significantly lower than those before operation (5.12 卤1.20)mm and 5.34 卤1.35mm), and there was no significant difference between the two groups before operation (P 0.05). The medial malleolus space in the experimental group was smaller than that in the control group (P 0.05). Conclusion 1) in order to improve the diagnostic accuracy of patients with ankle fracture associated with triangular ligament injury, we should carry out purposeful imaging examination on the basis of detailed medical history, clinical symptoms and related signs in order to improve the diagnostic accuracy. Repair of triangular ligament can promote the recovery of patients more effectively, promote the recovery of ankle function.) for the patients with deep deltoid ligament injury, we suggest that the first choice of surgery to restore the continuity and integrity of the triangular ligament.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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