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和临床疗效。方法2006年1月-2011年12月，在上海市同济医院，大连医科大学附属第一医院，武汉普爱医院和杭州萧山中医院手术治疗踝关节骨折患者1533例，对其中131例在骨折复位内固定的同时行三角韧带修复手术，男74例，女57例；年龄17～83岁，平均33.2岁。Lauge-Hansen分型：旋后外旋型Ⅳ度损伤42例，其中内踝前丘骨折合并三角韧带深层断裂患者5例；旋前外旋型Ⅲ度损伤36例，Ⅳ度损伤48例；旋前外展型Ⅲ度损伤5例； AO/OTA分类：43-B2型3例，44-B2型9例，44-B3型48例，44-C1型21例，44-C2型24例，44-C3型26例。在进行完骨折内固定后，术中均进行外旋应力试验，发现踝关节不稳定后，给予修复三角韧带。术后随访临床检查、影像学评估、美国骨科足踝学会(American Orthopaedic Foot and Ankle Society，AOFAS)踝-后足评分、视觉模拟评分(Visual Analogue Scale，VAS)和SF-36评分对临床结果进行评估。结果所有患者伤口均获Ⅰ期愈合，106例获得27个月(12～72个月)的随访，骨折愈合时间为14.5周(9～16周)。末次随访AOFAS踝-后足评分：91.4分(83～100分)，疼痛VAS为1.2分(0～6分)，SF-36评分为91.2分(80-96分)，患者均未出现踝关节不稳定。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，可以取得较满意的结果。
목적：탐토과관절골절합병삼각인대완전단렬적수술치료화림상료효。방법2006년1월-2011년12월，재상해시동제의원，대련의과대학부속제일의원，무한보애의원화항주소산중의원수술치료과관절골절환자1533례，대기중131례재골절복위내고정적동시행삼각인대수복수술，남74례，녀57례；년령17～83세，평균33.2세。Lauge-Hansen분형：선후외선형Ⅳ도손상42례，기중내과전구골절합병삼각인대심층단렬환자5례；선전외선형Ⅲ도손상36례，Ⅳ도손상48례；선전외전형Ⅲ도손상5례； AO/OTA분류：43-B2형3례，44-B2형9례，44-B3형48례，44-C1형21례，44-C2형24례，44-C3형26례。재진행완골절내고정후，술중균진행외선응력시험，발현과관절불은정후，급여수복삼각인대。술후수방림상검사、영상학평고、미국골과족과학회(American Orthopaedic Foot and Ankle Society，AOFAS)과-후족평분、시각모의평분(Visual Analogue Scale，VAS)화SF-36평분대림상결과진행평고。결과소유환자상구균획Ⅰ기유합，106례획득27개월(12～72개월)적수방，골절유합시간위14.5주(9～16주)。말차수방AOFAS과-후족평분：91.4분(83～100분)，동통VAS위1.2분(0～6분)，SF-36평분위91.2분(80-96분)，환자균미출현과관절불은정。결론대과관절골절합병삼각인대완전단렬적환자，수요합리적림상평고선택치료방안，근거단렬적부위선택괄당적수술봉합방법，가이취득교만의적결과。
Objective To investigate the surgical procedure and the clinical outcome about ankle fractures associated with whole deltoid ligament rupture. Methods From January 2006 to December 2011, 1533 ankle fractures operated, 131 deltoid ligament rupture were repaired simultaneously. They were 74 males and 57 females with a mean age of 33.2 years (range, 17-83 years). According to the Lauge-Hansen classification, 42 fractures were supination-external rotation type Ⅳ, 36 were pronation-external rotation type Ⅲ, 48 were pronation-external rotation type Ⅳ, and 5 were pronation-abduction type Ⅲ. According to the AO/OTA system, 1 fracture was 43-B2, 3 were 44-B2, 48 were 44-B3, 21 were 44-C1,2 were 44-C2, and 26 were 44-C3. Clinical examination,radiographs, AOFAS ankle-hindfoot scores, visual analogue scale(VAS) were used for outcome measurement. Results All wounds healed at the primary stage. 106 patients were followed up for 12 to 72 months, with the mean follow-up of 27 months. The mean time of bone union was 14.5 weeks (range, 9-16 weeks). The mean AOFAS ankle-hindfoot score at the last follow-up was 91.4 points (range, 83-100 points). The mean score of VAS was 1.2 points (range, 0-6 points).The means SF-36 score was 91.2(range,80-96) There was no ankle instability. Conclusion To achieve satisfactory outcomes for patients with ankle fractures associated with deltoid ligament rupture, a reasonable clinical evaluation and surgical procedure should be done, using a corresponding technique according to the site of deltoid ligament rupture.