目的:观察踝关节骨折伴随三角韧带损伤的手术治疗效果.方法:北京大学人民医院创伤骨科于2005年1月至2009年12月手术治疗了伴有三角韧带断裂的踝关节骨折16例,其中,AO分型A型2例、B型8例、C型6例,均对骨折行切开复位板钉或张力带内固定,三角韧带行切开探查并行手术修复以恢复踝关节内侧结构的稳定性.术后随访评价指标包括X线检查、美国骨科足踝协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分和视觉模拟评分(visual analogue scale,VAS).结果:全部病例得到30~84个月,平均47个月的随访.所有骨折均已愈合,骨折愈合时间平均12.8周(10~14周),未发生伤口并发症.AOFAS踝-后足功能评分:优8例,良8例,优良率100%,平均93分(85~100分).VAS为0.94分(0~2分).结论:在处理踝关节骨折时,应重视是否合并三角韧带损伤,如损伤严重,手术修复或重建断裂的三角韧带能取得良好的功能恢复结果.
Objective:To observe the clinical outcome after the surgical treatment of the deltoid liga- ment injury associated with ankle fractures. Methods: From January 2005 to December 2009, 16 deltoid ligament ruptures associated with ankle fractures were repaired. According to the AO/OTA system, 2 cases belonged to fracture A, 8 to B, and 6 to C. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analogue scale (VAS) were used for the outcome measurements. Results: The 16 patients were followed up for 30 to 84 months ,with the mean follow-up of 47 months. All wounds healed at the first stage. The mean time of bone union was 12.8 weeks (range: 10- 14 weeks). The mean AOFAS ankle-hindfoot score in the last follow-up was 93 points (range: 85 -100 points). The mean score of VAS was 0.94 points (range: 0 -2 points). Conclusion: Surgical treatment of ankle fractures associated with deltoid ligament rupture can achieve satisfactory outcomes, but it is important to decide the operation indication.