[Deltoid ligament augmentation and repairing in ankle fracture associated with deltoid ligament injury and syndesmosis diastasis].

Objective: To evaluate the outcome of the deep component augmentation and superficial component repairing and syndesmosis screw fixation in treating ankle fracture associated with deltoid ligament injury and syndesmosis diastasis. Methods: From January 2014 to December 2017, 16 patients with ankle fracture combined with deltoid ligament injury and syndesmosis diastasis were treated with the deep component augmentation and superficial component repairing in Beijing Jishuitan Hospital.Of the patients, 13 were males and 3 were females, with an average age of (38±10) years (21-57 years). Nine cases were athletic injuries, 4 cases were daily-life injuries and 3 cases were traffic injuries.According to the Weber classification, 6 cases were type B, 10 cases were type C. According to the Lauge-Hansen classification, 6 cases were supination external rotation Ⅳ injury, 9 cases were pronation external rotation Ⅳ injury, 1 case was pronation abduction Ⅲ injury.The surgical treatment method was rigid fixation of the lateral malleolus and deep deltoid ligament augamentation instead of syndesmosis screw fixation.The effect of the surgical method was observed. Results: The average follow up was (24±12) months (6-40 months). The mean degree of dorsiflexion was 17.8°±6.8° (5°-30°), with 3.8°±6.0° (0°-15°) less than that in normal side, the mean degree of plantar flexion was 46.9°±7.9°, with 1.9°±3.9° (0°-10°) less than that in normal side.The mean Philips and Schwartz score was 96.8±5.1 (82-100), the American Orthopaedic Foot and Ankle Society (AOFAS) Score was 97.4±4.6 (84-100). Conclusion: In the treatment of ankle fracture associated with deltoid ligament injury and syndesmosis diastasis, the deep component augmentation and superficial component repairing and proper rehabilitation can benefit the functional recovery.目的： 探讨在合并三角韧带损伤及下胫腓分离的踝关节骨折中使用三角韧带深层加强联合浅层修补替代传统下胫腓螺钉固定技术的效果。 方法： 2014年1月至2017年12月在北京积水潭医院使用缝合锚加强缝合修补三角韧带治疗合并三角韧带及下胫腓复合体损伤的踝关节骨折患者16例。其中男13例，女3例，平均年龄(38±10)岁(21～57岁)。运动伤9例，生活伤4例，交通伤3例。根据Weber分型，B型6例，C型10例；根据Lauge－Hansen分型，旋后外旋型损伤6例，旋前外旋型损伤9例，旋前外展型损伤1例。通过外踝接骨板、内侧三角韧带深层加强的术式治疗，而不行下胫腓螺丝钉固定。观察此术式的疗效。 结果： 患者平均随访(24±12)个月(6～40个月)。患侧踝关节背伸平均为17.8°±6.8°(5°～30°)，平均较健侧差3.8°±6.0°(0°～15°)；踝关节跖屈平均为46.9°±7.9°(40°～70°)，平均较健侧差1.9°±3.9°(0°～10°)。Philips&Schwartz评分平均为(96.8±5.1)分(82～100分)，美国足与踝关节协会评分平均(97.4±4.6)分(84～100分)。 结论： 在合并三角韧带损伤及下胫腓联合分离的踝关节骨折的治疗中，三角韧带深层加强联合浅层缝合可替代下胫腓螺钉。配合科学的康复指导，患者可获得良好功能恢复。.