切开复位内固定联合韧带修复术治疗踝关节骨折合并三角韧带损伤的疗效及对骨代谢的影响

目的探讨韧带修复联合切开复位内固定术(ORIF)治疗踝关节骨折合并三角韧带损伤的疗效及对骨代谢的影响。方法采用前瞻性病例对照研究分析2015年5月—2018年5月中山市中医院骨二科收治的55例踝关节骨折合并三角韧带损伤患者的临床资料,通过随机数字表法分为观察组28例和对照组27例。两组均接受ORIF治疗,对照组术中不修补三角韧带,观察组术中使用锚钉修复三角韧带。比较两组围术期情况、VAS评分、美国矫形外科足踝协会(AOFAS)评分、骨代谢指标、临床疗效及并发症。结果观察组手术时间明显较对照组长(110.84±13.61)min vs.(99.16±9.59)min,住院时间、骨折愈合时间明显较对照组短(15.64±2.07)d vs.(18.69±2.42)d,(11.36±1.88)周vs.(13.52±2.04)周,P<0.05;观察组术后1、3个月VAS评分均明显低于对照组(3.03±0.56)分vs.(3.62±0.71)分,(1.16±0.20)分vs.(2.23±0.28)分,P<0.5;术后6个月时,观察组AOFAS评分明显高于对照组(86.73±8.60)分vs.(77.50±7.94)分(P<0.05),且观察组血清骨碱性磷酸酶(BALP)、骨钙素(BGP)、1型前胶原氨基端延长肽(P1NP)明显高于对照组(139.34±16.70)U/L vs.(110.45±12.36)U/L,(7.45±1.05)μg/L vs.(5.98±0.78)μg/L,(131.46±12.76)μg/L vs.(114.74±10.01)μg/L,血清β胶原降解产物(β-CTX)明显低于对照组(0.33±0.05)μg/L vs.(0.49±0.06)μg/L,P<0.05;观察组临床疗效优良率明显高于对照组(89.29%vs.77.78%,P<0.05);两组术后并发症总发生率差异无统计学意义(3.57%vs.3.70%,P>0.05)。结论联合韧带修复在踝关节骨折合并三角韧带损伤患者ORIF治疗中疗效显著,可有效缓解术后疼痛,改善骨代谢,有助于促进骨质愈合及踝关节功能恢复,安全性好,值得应用推广。

Open reduction and internal fixation combined with ligament repair for the treatment of ankle fractures with triangular ligament injury and its effect on bone metabolism

Objective To study the curative efficacy of ligament repair combined with open reduction and internal fixation(ORIF)in the treatment of ankle fracture with deltoid ligament injury and its effect on bone metabolism.Methods Totally 55 patients of ankle fracture with deltoid ligament injury who received therapy from May 2015 to May 2018 in our hospital were selected for prospective research and analysis.According to the random number table,they were divided into 28 cases in the observation group and 27 cases in the control group.They all received ORIF treatment,and the control group did not repair the deltoid ligament during the operation,while the observation group used anchors to repair the deltoid ligament during the operation.The perioperative conditions,visual analogue scale(VAS),American Orthopaedic Food&Ankle Society(AOFAS)score,bone metabolism index,clinical efficacy and complication were compared between the two groups.Results The operation time in the observation group was significantly longer than that in the control group,and the hospital stay and fracture healing time of the observation group were significantly shorter than those in the control group(110.84±13.61)min vs.(99.16±9.59)min,(15.64±2.07)d vs.(18.69±2.42)d,(11.36±1.88)weeks vs.(13.52±2.04)weeks](P<0.05);the VAS score in observation group was significantly lower than that in control group at 1 and 3 months after operation(3.03±0.56)scores vs.(3.62±0.71)scores,(1.16±0.20)scores vs.(2.23±0.28)scores](P<0.05);at 6 months after operation,the AOFAS scores in the observation group was significantly higher than those in the control group(86.73±8.60)scores vs.(77.50±7.94)scores](P<0.05);the serum bone alkaline phosphatase(BALP),osteocalcin(BGP)and type 1 procollagen amino terminal prolonging peptide(P1NP)in the observation group were significantly higher than those in the control group,while the serumβ-collagen degradation product(β-CTX)was significantly lower than that in the control group(139.34±16.70)U/L vs.(110.45±12.36)U/L,(7.45±1.05)μg/L vs.(5.98±0.78)μg/L,(131.46±12.76)μg/L vs.(114.74±10.01)μg/L,(0.33±0.05)μg/L vs.(0.49±0.06)μg/L](P<0.05);the excellent and good rate of clinical efficacy in the observation group was significantly higher than that in the control group(89.29%vs.77.78%,P<0.05);there was no significant difference in the total incidence of postoperative complications between the two groups(3.57%vs.3.70%,P>0.05).Conclusion In the treatment of ankle fracture combined with deltoid ligament injury with ORIF,the effect of combined ligament repair is remarkable,which can effectively alleviate pain after operation,improve bone metabolism,promote bone healing and ankle function recovery,and it is safe and worth popularizing.