Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 20025, China.
Arch Orthop Trauma Surg. 2024 Jan;144(1):229-237. doi: 10.1007/s00402-023-05044-0. Epub 2023 Oct 15.
To evaluate the outcomes of patients with supination-adduction (SAD) type II (OTA/AO 44A2) fractures who had a lateral ankle ligament rupture repaired compared with patients who did not have a lateral ankle ligament repaired using patients who underwent fibula fracture fixation as a control group.
A retrospective analysis of all 104 patients diagnosed with SAD type II fractures from January 2011 to December 2020 and managed operatively was performed. The patients were divided into three groups: 32 patients with ruptures of the lateral ligaments that were not repaired (group A), 34 patients with ruptures of the lateral ligaments that were repaired (group B), and 38 patients with fibula fracture fixation acting as the control group (group C). The objective outcomes including radiographic findings, the ankle range of motion, the manual ankle stress tests, and complications were gained from the record of the last time in outpatient clinics. The functional outcomes including the identification of functional ankle instability (IdFAI) scores were collected postoperatively at 12-month intervals to assess clinical outcomes. The Manchester Oxford Foot Questionnaire (MOXFQ) and Karlsson scoring scale were also recorded at the last follow-up.
The mean follow-up of the objective and subjective functional outcomes was 23.4 (range, 13-42) and 76.9 (range, 25-134) months, respectively. There was no significant difference in the radiographic findings, the ankle range of motion and complications between the three groups. All ankles were found to be stable using the manual ankle stress test in both group A and group B. The IdFAI scores showed a significant difference between group A and group B (1.12 ± 1.3 vs 0.35 ± 0.69; p < 0.001) in the first year of follow-up and no significant difference after the first year. No differences were noted in MOXFQ scores or Karlsson scores among the groups.
Directly repairing the lateral ligament could minimize the proportion of the first year of postoperative functional ankle instability, although the final stability of the ankle and clinical outcomes were not significantly different in SAD type II fractures.
Level III, retrospective comparative case series.
评估旋后内收（SAD）Ⅱ型（OTA/AO 44A2）骨折患者中，与未修复外侧踝关节韧带断裂的患者相比，行外侧踝关节韧带修复术的患者的治疗结果，并将接受腓骨骨折固定术的患者作为对照组。
对 2011 年 1 月至 2020 年 12 月期间诊断为 SAD Ⅱ型骨折并接受手术治疗的 104 例患者进行回顾性分析。患者分为三组：未修复外侧韧带断裂的 32 例（A 组）、修复外侧韧带断裂的 34 例（B 组）和作为对照组的腓骨骨折固定术的 38 例（C 组）。从最后一次门诊就诊记录中获得客观结果，包括影像学发现、踝关节活动范围、手动踝关节应力试验和并发症。术后 12 个月，采用踝关节功能不稳定识别（IdFAI）评分评估临床结果，收集功能结果。末次随访时还记录了曼彻斯特-牛津足部问卷（MOXFQ）和 Karlsson 评分量表。
客观和主观功能结果的平均随访时间分别为 23.4（范围 13-42）和 76.9（范围 25-134）个月。三组之间的影像学发现、踝关节活动范围和并发症无显著差异。在 A 组和 B 组，手动踝关节应力试验均发现所有踝关节均稳定。IdFAI 评分在术后第一年，A 组和 B 组之间有显著差异（1.12±1.3 与 0.35±0.69；p<0.001），但在第一年之后无显著差异。三组之间的 MOXFQ 评分或 Karlsson 评分无差异。
直接修复外侧韧带可最大程度地降低 SAD Ⅱ型骨折术后第一年踝关节功能不稳定的比例，尽管在 SAD Ⅱ型骨折中，踝关节的最终稳定性和临床结果无显著差异。
Ⅲ级，回顾性比较病例系列。
