一期韧带修复联合拉力螺钉固定治疗踝关节不稳的疗效观察

目的：探讨一期韧带修复联合拉力螺钉固定治疗踝关节不稳的临床疗效。方法回顾性分析2011年1月至2013年6月间我科收治的34例急性踝关节外侧扭伤患者,男18例,女16例,年龄28.0~69.0岁,平均(49.3±1.9)岁。随机分为螺钉固定组和外固定组,每组各17例,分别采用一期带线铆钉原位修补联合拉力螺钉固定(螺钉固定组)和石膏或支具外固定治疗(外固定组)。所有患者术后患肢不负重,随访3个月,观察两组住院费用及并发症发生情况,根据美国足踝外科协会( American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分及视觉模拟评分法( visual analogue score, VAS)评价两种方法的治疗效果。结果螺钉固定组住院费用为(1.72±0.30)万元,外固定组为(0.68±0.20)万元,差异有统计学意义(P<0.05)。术后1、2、3个月随访AOFAS踝与后足评分,螺钉固定组为(66.2±1.3)分、(88.5±2.1)分、(97.2±1.9)分,外固定组为(46.8±1.6)分、(53.5±2.7)分、(75.6±1.2)分,差异有统计学意义(P<0.05)。采用VAS评分：螺钉固定组为(3.2±0.8)分、(2.5±0.6)分、(1.2±0.2)分,外固定组为(4.0±0.7)分、(3.1±0.6)分、(2.6±0.4)分,差异有统计学意义(P<0.05)。螺钉固定组所有患者术后未发生螺钉切出、断钉、创伤性关节炎、下胫腓不稳等并发症,外固定组中2例出现踝关节僵硬,经功能锻炼和物理疗法后有所缓解,4例术后3个月因疼痛和踝关节不稳二期行韧带重建术,恢复可。结论一期韧带修复联合拉力螺钉固定治疗急性踝关节不稳虽然住院费用较高,但并发症少,术后踝关节功能佳,是临床治疗踝关节扭伤的一种可行术式。

The effect of igament repairation combined with screw fixation in the treatment of patients with ankle instability

Objective: To investigate the clinical effect of one stage ligament repair combined with lag screw fixation in the treatment of ankle instability. Methods:34 cases of acute lateral ankle sprain from Jan 2011 to Jun 2013 in our department were retrospectively analyzed.They were randomly divided into control group and observation group, 17 cases in each group. Patients in the observation group were treated with line rivet repairation in situ combined with lag screw fixation and the others with plaster external fixation. The patients all exercised postoperatively with limb weight-bearing for 3 months. The two groups were observed in hospital costs and complications. The AOFAS and VAS score were statistics analyzed. Results: The hospitalization expenses was (1.72 0.3) million yuan in the observation group,and was higher than the control group [(0.68 0.2) million], p<0.05. After January, February and March follow-up ,the AOFAS score in the observation group was (66.2 1.3), (88.5 2.1), (97.2 1.9), while (46.8±1.6),(53.5±2.7),(75.6±1.2) in the control group, p<0.05. The VAS score in the observation group wre (3.2 0.8), (2.5 0.6), (1.2 0.2), while (4 0.7), (3.1 0.6), (2.6 - 0.4) in the control group, p<0.05. There was no screw broken, traumatic arthritis, lower tibiofibular ligament instability in the observation group. 2 cases in the control group appeared the ankle joint stiffness,and recovered after tfunction exercise and physical therapy. Conclusion: one stage repair of ligament combined with lag screw fixation has low cost of hospitalization, fewer complications, postoperative ankle function better, is an effective operative clinical treatment of ankle joint sprain.