不同修复方式对踝关节骨折伴三角韧带断裂的疗效及其生物力学特性的影响
|
摘要
目的探讨不同修复方式对踝关节骨折伴三角韧带断裂的疗效及其生物力学特性的影响。方法选取2011年6月至2016年5月汕头市澄海区人民医院收治的112例踝关节骨折伴三角韧带断裂患者为研究对象。按照就诊顺序编号随机分成对照组和观察组,每组56例,对照组予骨折内固定未三角韧带修复,观察组予骨折内固定并三角韧带修复,比较两组患者术后12周的治疗效果和术后6个月的生物力学特性指标的变化。结果观察组患者的治疗显效率和总有效率分别为53.57%、89.28%,明显高于对照组的37.5%、76.79%,差异均有统计学意义(P<0.05);观察组患者的疼痛、功能、活动度和总评分分别为(46.11±5.78)分、(25.67±3.45)分、(16.33±3.11)分、(90.34±10.11)分,均明显高于对照组的(40.55±6.98)分、(21.24±3.27)分、(12.45±2.94)分、(74.11±10.44)分,差异均有统计学意义(P<0.05);生物力学特性上,观察组患者的矢状面足跟着地角度为(4.56±1.56)°,明显低于对照组的(7.34±2.34)°,冠状面、水平面足跟着地角度分别为(2.11±1.23)°、(6.97±2.36)°,明显高于对照组的(-1.78±1.44)°、(5.25±2.34),两组比较差异均有统计学意义(P<0.05),而余矢状面、冠状面、水平面各指标组间比较,差异均无统计学意义(P>0.05)。结论踝关节骨折伴三角韧带断裂手术修复并三角韧带处理可明显降低对患者关节生物力学的影响,提高治疗效果,具有较高的临床应用价值。
Objective To investigate the effect of different repair methods on ankle fracture complicated with deltoid ligament disruption and its biomechanical characteristics. Methods A total of 112 patients with ankle fracture and deltoid ligament disruption were selected from Chenghai District People's Hospital of Shantou City from June 2011 to May 2016. The patients were assigned, according to the order of visiting, to receive internal fixation without deltoid ligament repair(the control group) or internal fixation and deltoid ligament repair(the observation group). The therapeutic effect of the two groups at 12 weeks after operation and the changes of biomechanical characteristics at 6 months after operation were observed and compared. Results The marked effective rate and total effective rate in the observation group were 53.57% and 89.28%, respectively, which were significantly higher than 37.5% and 76.79% in the control group(P<0.05). The pain, function, activity, and total score in the observation group were 46.11 ± 5.78, 25.67 ± 3.45,16.33±3.11, 90.34±10.11, respectively, significantly higher than 40.55±6.98, 21.24±3.27, 12.45±2.94, 74.11±10.44 in the control group(P<0.05). As for biomechanical characteristics, the heel landing angle on sagittal plane in the observation group was significantly lower than that of the control group:(4.56±1.56)° vs(7.34±2.34)°, P<0.05; the heel landing angle on coronal plane and horizontal plane in observation group were significantly higher:(2.11±1.23)° vs(-1.78±1.44)°,(6.97±2.36)° vs(5.25±2.34)°, both P<0.05; there was no significant difference in other indexes on the sagittal, coronal and horizontal plane(P>0.05). Conclusion Surgical repair of ankle fracture and deltoid ligament repair can significantly reduce the impact on joint biomechanics, improve the treatment effect, which thus has high clinical value.
Objective To investigate the effect of different repair methods on ankle fracture complicated with deltoid ligament disruption and its biomechanical characteristics. Methods A total of 112 patients with ankle fracture and deltoid ligament disruption were selected from Chenghai District People's Hospital of Shantou City from June 2011 to May 2016. The patients were assigned, according to the order of visiting, to receive internal fixation without deltoid ligament repair(the control group) or internal fixation and deltoid ligament repair(the observation group). The therapeutic effect of the two groups at 12 weeks after operation and the changes of biomechanical characteristics at 6 months after operation were observed and compared. Results The marked effective rate and total effective rate in the observation group were 53.57% and 89.28%, respectively, which were significantly higher than 37.5% and 76.79% in the control group(P<0.05). The pain, function, activity, and total score in the observation group were 46.11 ± 5.78, 25.67 ± 3.45,16.33±3.11, 90.34±10.11, respectively, significantly higher than 40.55±6.98, 21.24±3.27, 12.45±2.94, 74.11±10.44 in the control group(P<0.05). As for biomechanical characteristics, the heel landing angle on sagittal plane in the observation group was significantly lower than that of the control group:(4.56±1.56)° vs(7.34±2.34)°, P<0.05; the heel landing angle on coronal plane and horizontal plane in observation group were significantly higher:(2.11±1.23)° vs(-1.78±1.44)°,(6.97±2.36)° vs(5.25±2.34)°, both P<0.05; there was no significant difference in other indexes on the sagittal, coronal and horizontal plane(P>0.05). Conclusion Surgical repair of ankle fracture and deltoid ligament repair can significantly reduce the impact on joint biomechanics, improve the treatment effect, which thus has high clinical value.
引文
[1]蔡万松,姜跃国,周松杰,等.带线锚钉修复踝关节三角韧带断裂32例体会[J].浙江创伤外科, 2013, 18(6):881-882.
[2]贾少华,徐红伟,陆惠根,等.手术治疗合并有三角韧带损伤的踝关节骨折[J].河北医科大学学报, 2012, 33(6):690-692.
[3]李磊,阳波,刘东,等.踝关节骨折合并三角韧带断裂术中修复与不修复三角韧带的疗效比较[J].中国骨与关节损伤杂志, 2018, 33(4):430-432.
[4]胡涌亮,管四炎,王国庆,等.锚钉治疗内侧三角韧带完全断裂的踝关节骨折脱位[J].浙江创伤外科, 2013, 18(4):506-507.
[5] SIEGLER S, TOY J, SEALE D, et al. The Clinical Biomechanics Award 2013-Presented by the International Society of Biomechanics:New observations on the morphology of the talar dome and its relationship to ankle kinematics[J]. Clinical biomechanics, 2014, 29(1):1-6.
[6] LEUNG J, SMITH R, HARVEYL A, et al. The impact of simulated ankle plantarflexion contracture on the knee joint during stance phase of gait:A within-subject study[J]. Clinical biomechanics, 2014, 29(4):423-428.
[7]董伟强.踝关节韧带损伤对关节生物力学的影响和治疗方案选择[D].广州:南方医科大学, 2015.
[8]宋作成,闫小龙.踝关节胫骨远端关节面缺损生物力学特征的三维有限元分析[J].中国组织工程研究, 2016, 20(48):7212-7218.
[9]苏应军,童新延,胡力,等.以踝关节解剖结构及生物力学特征分析慢性踝关节不稳[J].中国组织工程研究, 2015, 9(15):2415-2419.
[10]董伟强,余斌,白波,等.下胫腓联合断裂对踝关节生物力学影响的研究[J].中华创伤骨科杂志, 2015, 17(6):532-535.
[11] SINITSKIE H, HANSENA H, WILKEN JM, et al. Biomechanics of the ankle-foot system during stair ambulation:Implications for design of advanced ankle-foot prostheses[J]. Journal of Biomechanics,2012, 45(3):588-594.
[12] BOYDB S, GRAYA T, DILLEY A, et al. The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus[J]. Clinical Biomechanics, 2012, 27(9):967-971.
[13]冯嘉威.下胫腓联合韧带不同程度损伤的稳定性研究[D].广州:南方医科大学, 2015.
[14]王晨.踝关节三角韧带解剖、损伤诊断与动态生物力学研究[D].上海:复旦大学, 2014.
[15]张明彦.踝关节三维有限元模型的建立及三角韧带损伤和重建的踝关节生物力学有限元分析[D].长沙:中南大学, 2012.
[16] TYSON SF, SADEGHI-DEMNEH E, NESTER C, et al. A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke[J]. Clinical rehabilitation, 2013, 27(10):879-891.
[17]汤俊君,吴克俭,张建,等.不同方式修复踝关节旋后外旋型Ⅳ度骨折伴三角韧带完全断裂的初步疗效比较[J].中华创伤骨科杂志,2016, 18(6):470-475.
[18]王淑丽,马信龙,徐卫国,等.外踝骨折后三角韧带损伤程度的X线与MRI比较研究[J].中华骨科杂志, 2013, 33(8):834-841.
[19]王勇卓,张民, MILTON ML,等.踝关节脱位是导致旋后外旋型踝关节骨折预后不良的危险因素[J].实用骨科杂志, 2016, 22(10):960.
[2]贾少华,徐红伟,陆惠根,等.手术治疗合并有三角韧带损伤的踝关节骨折[J].河北医科大学学报, 2012, 33(6):690-692.
[3]李磊,阳波,刘东,等.踝关节骨折合并三角韧带断裂术中修复与不修复三角韧带的疗效比较[J].中国骨与关节损伤杂志, 2018, 33(4):430-432.
[4]胡涌亮,管四炎,王国庆,等.锚钉治疗内侧三角韧带完全断裂的踝关节骨折脱位[J].浙江创伤外科, 2013, 18(4):506-507.
[5] SIEGLER S, TOY J, SEALE D, et al. The Clinical Biomechanics Award 2013-Presented by the International Society of Biomechanics:New observations on the morphology of the talar dome and its relationship to ankle kinematics[J]. Clinical biomechanics, 2014, 29(1):1-6.
[6] LEUNG J, SMITH R, HARVEYL A, et al. The impact of simulated ankle plantarflexion contracture on the knee joint during stance phase of gait:A within-subject study[J]. Clinical biomechanics, 2014, 29(4):423-428.
[7]董伟强.踝关节韧带损伤对关节生物力学的影响和治疗方案选择[D].广州:南方医科大学, 2015.
[8]宋作成,闫小龙.踝关节胫骨远端关节面缺损生物力学特征的三维有限元分析[J].中国组织工程研究, 2016, 20(48):7212-7218.
[9]苏应军,童新延,胡力,等.以踝关节解剖结构及生物力学特征分析慢性踝关节不稳[J].中国组织工程研究, 2015, 9(15):2415-2419.
[10]董伟强,余斌,白波,等.下胫腓联合断裂对踝关节生物力学影响的研究[J].中华创伤骨科杂志, 2015, 17(6):532-535.
[11] SINITSKIE H, HANSENA H, WILKEN JM, et al. Biomechanics of the ankle-foot system during stair ambulation:Implications for design of advanced ankle-foot prostheses[J]. Journal of Biomechanics,2012, 45(3):588-594.
[12] BOYDB S, GRAYA T, DILLEY A, et al. The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus[J]. Clinical Biomechanics, 2012, 27(9):967-971.
[13]冯嘉威.下胫腓联合韧带不同程度损伤的稳定性研究[D].广州:南方医科大学, 2015.
[14]王晨.踝关节三角韧带解剖、损伤诊断与动态生物力学研究[D].上海:复旦大学, 2014.
[15]张明彦.踝关节三维有限元模型的建立及三角韧带损伤和重建的踝关节生物力学有限元分析[D].长沙:中南大学, 2012.
[16] TYSON SF, SADEGHI-DEMNEH E, NESTER C, et al. A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke[J]. Clinical rehabilitation, 2013, 27(10):879-891.
[17]汤俊君,吴克俭,张建,等.不同方式修复踝关节旋后外旋型Ⅳ度骨折伴三角韧带完全断裂的初步疗效比较[J].中华创伤骨科杂志,2016, 18(6):470-475.
[18]王淑丽,马信龙,徐卫国,等.外踝骨折后三角韧带损伤程度的X线与MRI比较研究[J].中华骨科杂志, 2013, 33(8):834-841.
[19]王勇卓,张民, MILTON ML,等.踝关节脱位是导致旋后外旋型踝关节骨折预后不良的危险因素[J].实用骨科杂志, 2016, 22(10):960.