Yu Guang-rong, Zhang Ming-zhu, Aiyer Amiethab, Tang Xin, Xie Ming, Zeng Lin-ru, Zhao You-guang, Li Bing, Yang Yun-feng
Orthopedist, Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Orthopedist, Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD.
J Foot Ankle Surg. 2015 Mar-Apr;54(2):198-202. doi: 10.1053/j.jfas.2014.12.013. Epub 2015 Jan 21.
Controversy exists concerning the need for operative repair of the deltoid ligament during management of acute ankle fractures. The purpose of our report was to identify the indications for surgical intervention for deltoid ligament injury in the setting of ankle fractures. Furthermore, we aimed to elucidate the clinical outcomes after deltoid ligament repair in this setting. This was a multicenter study, involving 4 clinical institutions. From January 2006 to December 2011, 1533 ankle fractures underwent surgical intervention. Of this group, 131 deltoid ligament ruptures (8.55%) were identified and repaired operatively. Of the 131 patients, 74 were male (56.5%) and 57 were female (43.5%), with a mean age of 33.2 (range 16 to 63) years. The outcome measures included the clinical examination findings, radiographic findings, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, visual analog scale (VAS) scores, and Medical Outcomes Study Short Form 36-item questionnaire scores. All incisions healed primarily. A total of 106 patients were followed up for a minimum of 12 (range 12 to 72) months, with an average follow-up period of 27 months. The mean interval to fracture union was 14.5 (range 9 to 16) weeks. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score at the latest follow-up visit was 91.4 (range 83 to 100) points. The mean visual analog scale score was 1.2 (range 0 to 6) points. The mean Short Form-36 score was 91.2 (range 80 to 96) points. Compared with the preoperative scores, all the 3 outcome measures had improved significantly postoperatively (p < .05). The postoperative stress radiographs did not reveal any ankle instability. None had evidence of post-traumatic arthritis of the ankle from the clinical examination and radiographs. A reasonable clinical evaluation and surgical repair was executed, with an appropriate repair technique chosen according to the site of deltoid ligament rupture. The results of the present multicenter study have shown that deltoid ligament rupture can be repaired in patients with an unstable medial ankle after fracture fixation and prevent ankle stabilization-related complications.
在急性踝关节骨折的治疗过程中，关于三角韧带手术修复的必要性存在争议。我们报告的目的是确定踝关节骨折情况下三角韧带损伤的手术干预指征。此外，我们旨在阐明这种情况下三角韧带修复后的临床结果。这是一项多中心研究，涉及4个临床机构。从2006年1月至2011年12月，1533例踝关节骨折接受了手术干预。在该组中，确定了131例三角韧带断裂（8.55%）并进行了手术修复。在这131例患者中，男性74例（56.5%），女性57例（43.5%），平均年龄33.2岁（范围16至63岁）。结果指标包括临床检查结果、影像学检查结果、美国矫形足踝协会踝-后足评分、视觉模拟量表（VAS）评分和医学结局研究简明36项问卷评分。所有切口均一期愈合。共有106例患者随访至少12（范围12至72）个月，平均随访期为27个月。骨折愈合的平均间隔时间为14.5（范围9至16）周。在最近一次随访时，美国矫形足踝协会踝-后足评分的平均值为91.4（范围83至100）分。视觉模拟量表评分的平均值为1.2（范围0至6）分。简明36项评分的平均值为91.2（范围80至96）分。与术前评分相比，所有3项结果指标术后均有显著改善（p < 0.05）。术后应力位X线片未显示任何踝关节不稳定。临床检查和X线片均未发现有创伤后踝关节炎的证据。进行了合理的临床评估和手术修复，并根据三角韧带断裂的部位选择了合适的修复技术。本多中心研究结果表明，对于骨折固定后内侧踝关节不稳定的患者，三角韧带断裂可以修复，并可预防与踝关节稳定相关的并发症。
