锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的疗效

目的 探讨锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的临床疗效。方法 选取攀枝花市中西医结合医院2015年8月至2016年10月经踝关节X线确诊为踝关节骨折伴三角韧带损伤患者140例作为研究对象，按随机数字表随机分为观察组与对照组，每组各70例，观察组采用锚钉修补结合切开复位内固定治疗，对照组采用跨下胫腓联合螺钉固定方法治疗。治疗后采用Baird-Jackson评分，踝-后足评分（AOFAS评分），疼痛视觉模拟评分及评价手术疗效，术后随访6～12个月，平均8.4个月。结果 观察组患者Baird-Jackson评分优良率92.8%，对照组为77.1%，差异有统计学意义（P<0.05）。观察组患者术后AOFAS评分在术后1个月为（77.26±8.03）分，术后6个月为（94.12±8.63）分，较同期对照组高，差异有统计学意义（P<0.05）；术后12个月，两组患者术后AOFAS评分比较，差异无统计学意义（P>0.05）。观察组患者术后距骨倾斜角为（4.61±1.42）°，距骨前移距离为（3.09±1.21）cm，均短于对照组（P<0.05）。观察组患者疼痛视觉模拟评分治疗当天为（4.93±1.03）分，治疗后1个月为（2.14±0.92）分，对照组治疗当天为（5.12±1.06）分，治疗后1个月为（3.21±0.95）分，两组患者治疗后1个月比较，差异有统计学意义（P<0.05）。随访发现，骨折均顺利愈合，未出现内固定断裂、松动、骨折不愈合等不良事件。结论 锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤临床疗效良好。

Efficacy of anchor repair combined with open reduction internal fixation in treatment of ankle fracture with triangular ligament injury

Objective To investigate the clinical efficacy of anchor repair combined with open reduction internal fixation in the treatment of ankle fracture with triangular ligament injury.Methods A total of 140 patients with ankle fracture and triangular ligament injury diagnosed by ankle X-ray from August 2015 to October 2016 were chosen as the research object.According to the computer digital table, they were randomly divided into the observation group and the control group,with 70 cases in each group.The observation group was treated with anchor fixation combined with open reduction and internal fixation, while the control group with transcatheter tibiofibular screw fixation.After treatment,Baird-Jackson score, ankle-hind foot score (AOFAS score), pain visual analog scale were adoptedand the efficacy of surgery was thereby assessed.Postoperative follow-up was 6 to 12 months, withan average of 8.4 months.Results The excellent and good rate of Baird-Jackson score was 92.8% in the observation group and 77.1% in the control group, and the differencehad statistical significance(P<0.05).The AOFAS score in the observation group 1 month after surgery was (77.26±8.03) points, 6 months after surgery was(94.12±8.63) points,whichwere higher than that ofthe control group of the same time, and the differencewas statistically significant (P<0.05).There was no significant difference in AOFAS score between the two groups 12 months after surgery (P>0.05).The oblique angle of the talus was (4.61±1.42) °, and the distance from the talus was (3.09±1.21) cm,both of which were shorter than those in the control group (P<0.05).In the observation group, the pain visual analogue score was (4.93±1.03), and1 month after treatment was (2.14±0.92) points.In the control group, the day of treatment was (5.12±1.06) points, and1 month after treatment was (3.21±0.95) points.There wassignificant difference between the two groups after 1 month of treatment (t=5.661, P=0.03).Follow-up indicated that fractures were successfully healed, withoutinternal fixation rupture, loose, nonunion and other adverse events.Conclusion Ankle fixation combined with open reduction and internal fixation is effective in the treatment of ankle fracture with triangular ligament injury.