距腓前韧带解剖修复治疗伴有外侧副韧带损伤的外踝撕脱骨折的临床效果

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摘要目的通过比较手术修复和单纯石膏固定治疗对外侧副韧带损伤伴有外踝撕脱骨折患者的临床效果，为外侧副韧带损伤合并外踝撕脱骨折患者临床治疗提供参考。方法将2017年8月至2021年6月首都医科大学附属北京朝阳医院北京市昌平区中医医院治疗的63例外侧副韧带损伤伴有外踝撕脱骨折的患者纳入研究。按照手术方法将纳入患者分为两组，A组33例行距腓前韧带解剖修复手术治疗（根据骨折块大小行固定及切除手术），B组30例行石膏固定治疗。两组治疗后定期随访观察患侧踝关节的疼痛、活动度、行走步态及运动状况等指标，比较并分析二组手术前后视觉模拟评分法（VAS）疼痛评分、美国骨科协会足踝外科分会评分（AOFAS）评分及Karlsson-Peterso踝关节功能评分、距骨前移距离。结果两组VAS评分组间、时间及交互作用比较，差异有统计学意义（P ＜ 0.05）。其中，两组术后6、18个月低于术前，术后18个月低于术后6个月，差异有统计学意义（P ＜ 0.05）；A组术后6个月VAS评分低于B组，差异有统计学意义（P ＜ 0.05）。两组术后Karlsson评分高于术前，且A组高于B组，差异有统计学意义（P ＜ 0.05）。两组AOFAS评分组间、时间及交互作用比较，差异有统计学意义（P ＜ 0.05）。两组术后1、3、18个月AOFAS评分高于术前，A组术后3、18个月AOFAS评分高于术后1个月，两组术后18个月AOFAS评分高于术后3个月，差异有统计学意义（P ＜ 0.05）；A组术后3、18个月AOFAS评分高于B组，差异有统计学意义（P ＜ 0.05）。两组距骨前移距离差组间、时间及交互作用比较，差异有统计学意义（P ＜ 0.05）。其中两组术后12、18个月距骨前移距离差低于术前，术后18个月距骨前移距离差高于术后12个月，差异有统计学意义（P ＜ 0.05）；A组术后12、18个月距骨前移距离差高于B组，差异有统计学意义（P ＜ 0.05）。结论距腓前韧带解剖修复治疗伴有外侧副韧带损伤外踝撕脱性骨折较保守石膏固定治疗具有更好的疗效，恢复更快，关节稳定性更好。

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	马胡晶刘洋周君琳▲

关键词 ：外踝撕脱性骨折, 踝关节外侧副韧带损伤, 手术治疗, 保守治疗

Abstract：Objective To compare the clinical effects of surgical repair and simple plaster immobilization on patients with lateral collateral ligament injury and lateral malleolar avulsion fracture, in order to provide reference for the clinical treatment of patients with lateral collateral ligament injury and lateral malleolus avulsion fracture. Methods A total of 63 patients with lateral collateral ligament injury and lateral malleolus avulsion fracture treated in Beijing Chaoyang Hospital, Capital Medical University, from August 2017 to June 2021 were included in this study. According to the surgical method, the included patients were divided into two groups. Thirty-three cases in group A were treated with anatomic repair of the anterior talofibular ligament (fixation and resection according to the size of the fracture fragment), and 30 cases in group B were treated with plaster immobilization. After treatment, the two groups were followed up regularly to observe the pain, range of motion, walking gait and movement status of the affected ankle joint. The visual analog scale (VAS) pain score, American orthopedic foot and ankle society (AOFAS) score, Karlsson-Peterso ankle joint function score, and talus anterior displacement were compared and analyzed before and after operation. Results There were statistically significant differences of the VAS scores between the two groups, time and interaction (P ＜ 0.05). Among them, the 6 and 18 months after operation in the two groups were lower than those before operation, and the 18 months after operation was lower than that at 6 months after operation, and the differences were statistically significant (P ＜ 0.05); 6 months after operation the VAS score of group A was lower than that of group B, and the difference was statistically significant (P ＜ 0.05). The postoperative Karlsson score of the two groups were higher than that before operation, while the group A was higher than the group B, and the differences were statistically significant (P ＜ 0.05). There were statistically significant differences of AOFAS score between the two groups, time and interaction (P ＜ 0.05). The AOFAS scores of the two groups at 1, 3, and 18 months after the operation were higher than those before the operation, while the AOFAS scores of the group A at the 3 and 18 months after the operation were higher than those at the 1 month after the operation, and the AOFAS scores of the two groups at 18 months after the operation were higher than those at 3 months after the operation, and the differences were statistically significant (P ＜ 0.05); the AOFAS score of group A was higher than that of group B at 3 and 18 months after operation, and the differences were statistically significant (P ＜ 0.05). There were statistically significant differences in the distance of talus advancement difference between the two groups, time and interaction (P ＜ 0.05). Among the two groups, the distance of talus advancement difference at 12 and 18 months after operation were lower than that before operation, while the distance of talus advancement difference at 18 months after operation was higher than that at 12 months after operation, and the differences were statistically significant (P ＜ 0.05); at 12 and 18 months after operation, the distance of talus advancement difference in group A were higher than that in group B, and the differences were statistically significant (P ＜ 0.05). Conclusion Anatomical repair of the anterior talofibular ligament in the treatment of avulsion fractures of the lateral malleolus with lateral collateral ligament injury is more effective than conservative plaster immobilization, with faster recovery and better joint stability.

Key words： Avulsion fracture of lateral malleolus Lateral collateral ligament injury of ankle Surgical treatment Conservative treatment

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引用本文:

马胡晶刘洋周君琳▲. 距腓前韧带解剖修复治疗伴有外侧副韧带损伤的外踝撕脱骨折的临床效果[J]. 中国医药导报, 2022, 19(9): 99-102,119.
MA Hujing LIU Yang ZHOU Junlin▲. Clinical effect of anatomical repair of anterior talofibular ligament in the treatment of lateral malleolus avulsion fracture with lateral collateral ligament injury#br#. 中国医药导报, 2022, 19(9): 99-102,119.

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