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[1]呂巖,王愛(ài)國(guó),馬富強(qiáng),等.切開(kāi)復(fù)位T形鈦板聯(lián)合帶線(xiàn)錨釘內(nèi)固定治療單純后踝骨折合并距腓前韌帶損傷的臨床研究[J].中醫(yī)正骨,2023,35(01):30-35.
　LV Yan,WANG Aiguo,MA Fuqiang,et al.A clinical study of open reduction combined with T-type titanium plate and suture anchor internal fixation in the treatment of posterior malleolus fractures complicated with anterior talofibular ligament injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(01):30-35.
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切開(kāi)復(fù)位T形鈦板聯(lián)合帶線(xiàn)錨釘內(nèi)固定治療單純后踝骨折合并距腓前韌帶損傷的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年01期
頁(yè)碼:
30-35
欄目:
臨床研究
出版日期:
2023-01-20

文章信息/Info

Title:
A clinical study of open reduction combined with T-type titanium plate and suture anchor internal fixation in the treatment of posterior malleolus fractures complicated with anterior talofibular ligament injury
作者:
呂巖1; 王愛(ài)國(guó)2; 馬富強(qiáng)2; 李翔2; 白玉2
(1.河南中醫(yī)藥大學(xué)第一臨床醫(yī)學(xué)院,河南 鄭州 450046; 2.鄭州市骨科醫(yī)院,河南 鄭州 450052)
Author(s):
LV Yan1; WANG Aiguo2; MA Fuqiang2; LI Xiang2; BAI Yu2
1.First School of Clinical Medicine,Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China 2.Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
踝關(guān)節(jié);  踝損傷;  踝部骨折;  外側(cè)韌帶; 踝;  距腓前韌帶;  骨折固定術(shù); 內(nèi);  縫合錨;  臨床試驗(yàn)
Keywords:
ankle joint;  ankle injuries;  ankle fractures;  lateral ligament; ankle;  anterior talofibular ligament;  fracture fixation; internal;  clinical trial
摘要:
目的:比較切開(kāi)復(fù)位T形鈦板聯(lián)合帶線(xiàn)錨釘內(nèi)固定與單純切開(kāi)復(fù)位T形鈦板內(nèi)固定治療單純后踝骨折合并距腓前韌帶(anterior talofibular ligament,ATFL)損傷的臨床療效和安全性。方法:回顧性分析48例單純后踝骨折合并ATFL損傷患者的病例資料,均采用切開(kāi)復(fù)位T形鈦板內(nèi)固定治療,其中術(shù)中采用帶線(xiàn)錨釘修復(fù)ATFL損傷24例(ATFL修復(fù)組)、未修復(fù)ATFL損傷24例(ATFL未修復(fù)組)。比較2組患者的骨折愈合時(shí)間,術(shù)前和術(shù)后1年的踝部疼痛視覺(jué)模擬量表(visual analogue scale,VAS)評(píng)分、距骨前移距離,術(shù)后1年的美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopedic Foot and Ankle Society,AOFAS)踝與后足功能評(píng)分,以及并發(fā)癥發(fā)生情況。結(jié)果:①骨折愈合時(shí)間。ATFL修復(fù)組骨折愈合時(shí)間與ATFL未修復(fù)組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(11.83±1.13)周,(11.67±0.82)周,t=0.586,P=0.561]。②踝部疼痛VAS評(píng)分。術(shù)前,2組患者踝部疼痛VAS評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(6.08±0.72)分,(6.04±0.55)分,t=0.226,P=0.822]; 術(shù)后1年,ATFL修復(fù)組患者踝部疼痛VAS評(píng)分低于A(yíng)TFL未修復(fù)組[(1.04±0.46)分,(2.54±1.22)分,t=-5.649,P=0.000],2組患者踝部疼痛VAS評(píng)分均低于術(shù)前(t=32.906,P=0.000; t=14.103,P=0.000)。③距骨前移距離。術(shù)前,2組患者距骨前移距離比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(10.71±1.12)mm,(10.54±1.02)mm,t=0.538,P=0.593]; 術(shù)后1年,ATFL修復(fù)組患者距骨前移距離小于A(yíng)TFL未修復(fù)組[(2.25±0.74)mm,(4.88±1.48)mm,t=-7.762,P=0.000],2組患者距骨前移距離均小于術(shù)前(t=31.259,P=0.000; t=15.140,P=0.000)。④AOFAS踝與后足功能評(píng)分。術(shù)后1年,ATFL修復(fù)組患者AOFAS踝與后足功能評(píng)分高于A(yíng)TFL未修復(fù)組[(92.71±6.56)分,(84.71±6.68)分,t=4.186,P=0.000]。⑤安全性。ATFL修復(fù)組1例出現(xiàn)外踝處皮膚感覺(jué)減退,ATFL未修復(fù)組5例出現(xiàn)慢性踝關(guān)節(jié)不穩(wěn)、2例出現(xiàn)距骨骨軟骨損傷。2組患者均未出現(xiàn)骨不連、感染、內(nèi)固定失效等并發(fā)癥。ATFL修復(fù)組并發(fā)癥發(fā)生率低于A(yíng)TFL未修復(fù)組(χ2=5.400,P=0.020)。結(jié)論:與采用單純切開(kāi)復(fù)位T形鈦板內(nèi)固定相比,采用切開(kāi)復(fù)位T形鈦板聯(lián)合帶線(xiàn)錨釘內(nèi)固定治療單純后踝骨折合并ATFL損傷,能更好地緩解踝關(guān)節(jié)疼痛、改善踝關(guān)節(jié)功能、減少并發(fā)癥發(fā)生,但二者在促進(jìn)骨折愈合方面療效相當(dāng)。
Abstract:
Objective:To compare the clinical efficacy and safety of open reduction combined with T-type titanium plate and suture anchor internal fixation and open reduction combined with T-type titanium plate internal fixation in the treatment of posterior malleolus fractures complicated with anterior talofibular ligament(ATFL)injury.Methods:The medical data of 48 patients with posterior malleolus fractures complicated with ATFL injury,who were treated with open reduction combined with T-type titanium plate internal fixation,were retrospectively analyzed,including 24 cases with ATFL injury repaired by suture anchors(the ATFL repair group)and 24 cases with ATFL injury unrepaired(the ATFL non-repair group).The fracture healing time,ankle pain visual analogue scale(VAS)scores and anterior tibial translocation(ATT)measured before operation and at one year after operation,American Orthopedic Foot and Ankle Society(AOFAS)Ankle-Hindfoot Scale scores measured at one year after operation,and the occurrence of complications were compared between the two groups.Results:①Fracture healing time.There was no significant difference in fracture healing time between the ATFL repair group and the ATFL non-repair group(11.83±1.13 vs 11.67±0.82 weeks,t=0.586,P=0.561).②A(yíng)nkle pain VAS score.Before operation,there was no significant difference in ankle pain VAS scores between the two groups(6.08±0.72 vs 6.04±0.55 points,t=0.226,P=0.822).One year after operation,the ankle pain VAS score in the ATFL repair group was lower than that in the ATFL non-repair group(1.04±0.46 vs 2.54±1.22 points,t=-5.649,P=0.000).For both groups,the ankle pain VAS scores were lower than those before operation(t=32.906,P=0.000; t=14.103,P=0.000).③ATT.Before operation,there was no significant difference in the ATT between the two groups(10.71±1.12 vs 10.54±1.02 mm,t=0.538,P=0.593).One year after operation,the ATT in the ATFL repair group was smaller than that in the ATFL non-repair group(2.25±0.74 vs 4.88±1.48 mm,t=-7.762,P=0.000).For both groups,the ATT was smaller than that before operation(t=31.259,P=0.000; t=15.140,P=0.000).④AOFAS Ankle-Hindfoot Scale score.One year after operation,the AOFAS Ankle-Hindfoot Scale score in the ATFL repair group was higher than that in the ATFL non-repair group(92.71±6.56 vs 84.71±6.68 points,t=4.186,P=0.000).⑤Safety.In the ATFL repair group,one case suffered from hypoesthesia on the lateral malleolus,while in the ATFL non-repair group,five cases developed chronic ankle instability,and two cases had osteochondral lesions of the talus.There were no complications,such as nonunion,infection,and failure of internal fixation in the two groups.The incidence of complications in the ATFL repair group was lower than that in the ATFL non-repair group(χ2=5.400,P=0.020).Conclusion:Compared with open reduction combined with T-type titanium plate internal fixation,open reduction combined with T-type titanium plate and suture anchor internal fixation in the treatment of posterior malleolus fractures complicated with ATFL injury can relieve ankle pain,improve ankle function,and reduce complications in a better way.They are equivalent in promoting fracture healing.

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(收稿日期:2022-08-03 本文編輯:時(shí)紅磊)

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備注/Memo:
通訊作者:王愛(ài)國(guó) E-mail:[email protected]
更新日期/Last Update: 1900-01-01