踝关节镜检在治疗急性踝关节骨折中的作用

目的探讨应用关节镜探查急性踝关节骨折时关节内合并病变,并辅助进行踝关节骨折的复位及固定的可能性及优缺点。 方法回顾性分析中山大学孙逸仙纪念医院骨科2016年3月至2017年11月诊断为"急性踝关节骨折"的患者,共78例。所有患者在行踝关节镜检＋切开复位内固定,记录关节镜下软骨损伤、三角韧带损伤、下胫腓联合损伤及游离碎片,采用卡方检验分析关节内病变与骨折类型的相关性。 结果在所有患者中,Weber A型骨折6例,Weber B型骨折45例,Weber C型骨折27例。骨软骨损伤共51例,其中Weber A/B/C分别0/33/18例;胫腓联合损伤39例,其中Weber A/B/C分别0/18/21例;三角韧带损伤27例,其中Weber A/B/C分别0/21/6例;关节腔游离碎片7例,其中Weber A/B/C分别0/4/3例。Weber B型骨折与Weber C骨折距骨软骨损伤发生无统计学差异(χ²＝0.363,P >0.05),但软骨损伤程度,Weber B型骨折更重(Fisher确切检验,P ＝0.007)。胫腓联合损伤,Weber B型骨折与Weber C骨折两组之间相比无统计学差异(χ²＝ 2.4 ,P >0.05);在Weber C骨折中,后踝骨折与胫腓联合不稳明显相关(Fisher确切检验,P ＝0.02)。三角韧带损伤,Weber B型骨折与Weber C骨折两组之间相比有统计学差异(χ²＝4.302, P<0.05);但当将内踝骨折与三角韧带损伤定义为内侧不稳时,两组之间无统计学差异(Fisher确切检验,P ＝0.07)。 结论在急性踝关节骨折时,关节镜探查可同时发现并处理合并的踝关节内病变,并辅助进行踝关节骨折的复位及固定,是提高切开内固定手术疗效的有益辅助工具。

Role of arthroscopy in treatment of acute ankle fractures

ObjectiveTo explore the role of the arthroscopy in treatment of intra-articular lesions when an ankle joint has an acute fracture, and to evaluate advantages and disadvantages. MethodsSeventy-eight patients with acute ankle fracture were treated with arthroscopy combined with open reduction and internal fixation from March 2016 to November 2017 in Sun Yat-sen Memorial Hospital.The cartilage injury, the damage of the deltoid ligament, the injury of the distal tibiofibular syndesmosis and the free fragments were recorded, and the correlation with the type of fracture was analyzed by chi-square test. ResultsIn all the patients, six patients were suffered with type Weber A fracture, 45 were type Weber B fracture, 27 were type Weber C fracture. Cartilage injury was found in 51 patients (Weber A/B/C: 0/33/18), the distal tibiofibular syndesmosis injury was found in 39 patients(Weber A/B/C: 0/18/21), the deltoid ligament damage was in 27 patients(Weber A/B/C: 0/21/6), free fragments were found in seven patients(Weber A/B/C: 0/4/3 ). There was no significant difference between Weber B and Weber C in regard to the cartilage injury (χ²=0.363, P>0.05), but the degree of the cartilage injury was more sever in Weber B(Fisher’s exact test, P=0.007). There was no significant difference between Weber B and Weber C in regard to the distal tibiofibular syndesmosis(χ²=2.4 , P>0.05); in Weber C, the distal tibiofibular syndesmosis unstable was obvious correlated to posterior malleolus fracture(Fisher ’s exact test, P=0.02). There was significant difference between Weber B and Weber C in regard to the incidence of deltoid ligament injury(χ²=4.302, P<0.05); while the incidence of the medial malleolus fracture and the deltoid ligament injury was defined as medial instability of ankle, no significant difference was found between Weber B and Weber C (Fisher ’s exact test, P=0.07). ConclusionIn treatment of acute ankle fracture, arthroscopy could find and deal with intra-articular lesions , also assist reduction and internal fixation, which is a useful auxiliary tool to improve the curative effect.