Choi SeongJu, Choi Youngrak, Baek Eugene, Jo Seongmin
Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea.
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic road 43-gil, Songpa-gu, Seoul, 05505, Korea.
Arch Orthop Trauma Surg. 2022 Apr;142(4):535-541. doi: 10.1007/s00402-020-03645-7. Epub 2020 Oct 29.
To analyze the radiographic and clinical outcomes of deltoid ligament repair, we studied 34 supination external rotation type IV ankle fracture patients with deltoid ruptures who required syndesmosis fixation.
We retrospectively evaluated 34 cases of ruptured deltoid ligaments with associated supination external rotation type IV ankle fractures with a widening of the syndesmosis between 2011 and 2017. All of the ankle fractures were treated with a similar surgical protocol (plate and screw fixation). Syndesmotic fixations were performed on all patients. The deltoid ligaments were surgically repaired in 19 patients and in 15 patients, they were not. The preoperative, immediate postoperative, and final follow-up radiographic outcomes (medial clear space, overlap space, and clear space) and clinical scores (Foot and Ankle Outcome Scores and the Foot Function Index) were compared. Patients were followed for an average of 13.6 months.
There was no significant difference in radiographic and clinical outcomes between the deltoid repair group and the unrepair group (P > 0.05). In both groups, the mean immediate postoperative radiographic outcomes were satisfactory, showing reduced MCS, reduced CS, and increased OS to within-normal ranges that were maintained at the final follow-up. Clinical outcomes were similar between the two groups (P > 0.05). The rate of complications, such as intra-articular lesions, malunions, nonunions, and arthrosis was comparable between the two groups.
In both groups, the postoperative and final follow-up radiographic measures were within normal ranges and the radiographic and clinical outcomes were not significantly different between the two groups. Syndesmotic reduction could be much more important than deltoid repair in regard to mortise restoration and medial stability.
为分析三角韧带修复的影像学及临床疗效，我们研究了34例合并三角韧带断裂且需要下胫腓联合固定的旋后外旋IV型踝关节骨折患者。
我们回顾性评估了2011年至2017年间34例合并旋后外旋IV型踝关节骨折且伴有下胫腓联合增宽的三角韧带断裂病例。所有踝关节骨折均采用相似的手术方案（钢板螺钉固定）进行治疗。所有患者均进行了下胫腓联合固定。19例患者对三角韧带进行了手术修复，15例患者未进行修复。比较术前、术后即刻及末次随访时的影像学结果（内侧间隙、重叠间隙和间隙）及临床评分（足踝结果评分和足部功能指数）。患者平均随访13.6个月。
三角韧带修复组与未修复组在影像学及临床疗效方面无显著差异（P>0.05）。两组术后即刻的平均影像学结果均令人满意，内侧间隙减小、间隙减小，重叠间隙增加至正常范围内，并在末次随访时维持。两组临床疗效相似（P>0.05）。两组关节内病变、畸形愈合、不愈合及关节炎等并发症发生率相当。
两组术后及末次随访时的影像学测量均在正常范围内，两组在影像学及临床疗效方面无显著差异。就关节窝恢复及内侧稳定性而言，下胫腓联合复位可能比三角韧带修复更为重要。
