CAJ | 학술논문

目的探讨踝关节骨折合并三角韧带完全断裂的手术治疗方法和临床疗效. 方法对2006年1月至2010年12月收治的48例踝关节骨折合并三角韧带完全断裂患者的病例资料进行回顾性研究,男26例,女22例；年龄17～74岁,平均44.2岁.损伤按照Lauge-Hansen分类:旋后外旋型Ⅳ度损伤14例；旋前外旋型Ⅲ度损伤12例,Ⅳ度损伤16例；旋前外展型Ⅲ度损伤5例.骨折按照AO/OTA分型:43-B2型1例,44-B2型3例,44-B3型16例,44-C1型7例,44-C2型8例,44-C3型13例.所有患者在骨折复位固定的同时修复三角韧带.术后通过临床检查、影像学评估、美国足踝外科学会(AOFAS)踝-后足评分和视觉模拟评分(VAS)对临床结果进行评估. 结果所有患者伤口均获一期愈合.43例患者术后获12 ～ 32个月(平均19个月)随访,骨折愈合时间为10～16周(平均13.2周).末次随访时AOFAS踝-后足评分为83～100分(平均93.4分),VAS评分为0～6分(平均1.2分),无踝关节不稳定表现. 结论对踝关节骨折合并三角韧带完全断裂的患者,需要合理的临床评估后再选择治疗方案,根据断裂的部位选择适当的手术缝合方法,可以取得较满意的效果.
목적 탐토과관절골절합병삼각인대완전단렬적수술치료방법화림상료효. 방법 대2006년1월지2010년12월수치적48례과관절골절합병삼각인대완전단렬환자적병례자료진행회고성연구,남26례,녀22례；년령17～74세,평균44.2세.손상안조Lauge-Hansen분류:선후외선형Ⅳ도손상14례；선전외선형Ⅲ도손상12례,Ⅳ도손상16례；선전외전형Ⅲ도손상5례.골절안조AO/OTA분형:43-B2형1례,44-B2형3례,44-B3형16례,44-C1형7례,44-C2형8례,44-C3형13례.소유환자재골절복위고정적동시수복삼각인대.술후통과림상검사、영상학평고、미국족과외과학회(AOFAS)과-후족평분화시각모의평분(VAS)대림상결과진행평고. 결과 소유환자상구균획일기유합.43례환자술후획12 ～ 32개월(평균19개월)수방,골절유합시간위10～16주(평균13.2주).말차수방시AOFAS과-후족평분위83～100분(평균93.4분),VAS평분위0～6분(평균1.2분),무과관절불은정표현. 결론 대과관절골절합병삼각인대완전단렬적환자,수요합리적림상평고후재선택치료방안,근거단렬적부위선택괄당적수술봉합방법,가이취득교만의적효과.
Objective To investigate the surgical procedure and clinical outcome of treatment of ankle fractures associated with completer rupture of the deltoid ligament.Methods From January 2006 to December 2010,we treated 48 cases of ankle fracture associated with complete rupture of the deltoid ligament rupture.They were 26 males and 22 females,with an average age of 44.2 years (range,17 to 74 years).According to the Lauge-Hansen classification,there were 14 cases of supination-external rotation type Ⅳ,12 pronation-external rotation type Ⅲ,16 pronation-external rotation type Ⅳ and 5 pronation-abduction type Ⅲ.According to the AO/OTA system,there were one case of 43-B2,3 cases of 44-B2,16 44-B3,7 44-C1,844-C2,and 13 44-C3.Reduction and fixation of the fracture and repair of the ruptured ligament were conducted simultaneously for all patients.Clinical examinations,radiographs,American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hindfoot scores and visual analogue scale (VAS) were used for outcome measurement.Results All wounds healed at the first stage.Forty-three patients were followed up for 12 to 32 months,with an average of 19 months.The mean time for bone union was 13.2 weeks (range,10 to 16 weeks).The mean AOFAS ankle-hindfoot score at the last follow-up was 93.4 points (range,83 to 100 points).The mean VAS score was 1.2 points (range,0 to 6 points).There was no ankle instability.Conclusion To achieve satisfactory outcomes for patients with ankle fractures associated with complete rupture of the deltoid ligament,a proper surgical procedure should be chosen according to reasonable preoperative evaluation and a proper suture technique according to the rupture site of the deltoid ligament.