中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (11): 1793-1798.doi: 10.12307/2022.368

• 组织构建综述 tissue construction review • 上一篇    下一篇

踝关节骨折伴三角韧带损伤的修复与重建

李琪琛1,韩树峰2,贾二龙2,贾雅楠1   

  1. 1山西医科大学,山西省太原市   030001;2山西医科大学第一医院骨科,山西省太原市   030001
  • 收稿日期:2021-01-11 修回日期:2021-01-13 接受日期:2021-03-22 出版日期:2022-04-18 发布日期:2021-12-13
  • 通讯作者: 韩树峰,硕士,主任医师,教授,山西医科大学第一医院骨科,山西省太原市 030001
  • 作者简介:李琪琛,男,1994年生,山西省和顺县人,汉族,山西医科大学在读硕士,主要从事创伤骨科及足踝外科研究。

Ankle joint fracture with deltoid ligament injury: repair and reconstruction

Li Qichen1, Han Shufeng2, Jia Erlong2, Jia Yanan1   

  1. 1Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2Department of Orthopedics, the First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2021-01-11 Revised:2021-01-13 Accepted:2021-03-22 Online:2022-04-18 Published:2021-12-13
  • Contact: Han Shufeng, Master, Chief physician, Professor, Department of Orthopedics, the First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Li Qichen, Master candidate, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China

摘要:

文题释义:
踝关节三角韧带组成:三角韧带是一个大型扇面韧带复合体,分为深浅两层,其中浅层包括胫弹簧韧带、胫舟韧带、胫距后浅韧带和胫跟韧带;深层包括胫距前深韧带与胫距后深韧带。
踝关节三角韧带功能:三角韧带在维持踝关节正常生物力学稳定性中起着的关键作用,主要限制距骨前、后、外侧外翻移位,以及引导距骨在踝穴中进行正常生理运动。

背景:三角韧带在维持踝关节正常生物力学稳定性中起着关键作用。三角韧带的损伤处理不当可造成创伤性关节炎、慢性踝关节不稳等,但目前对于踝关节骨折伴三角韧带损伤的诊疗方案仍然存在争议。
目的:对踝关节骨折伴三角韧带损伤的诊断及修复与重建的进展进行综述。
方法:英文以“ankle,deltoid ligament,diagnosis,management”为检索词;中文以“踝关节、三角韧带、诊断、治疗”为检索词,在PubMed、中国知网、VIP中国期刊网检索相关文献,初级共检出文献 290 篇,其中69 篇文献符合纳入标准。
结果与结论:①三角韧带限制了距骨外翻外旋,起着维持踝关节内侧稳定性的重要作用;三角韧带受损后踝关节内侧稳定性降低,后足力线逐渐发生变化,随后出现扁平足等相关畸形,长期将导致踝关节骨软骨退行性变的发生;②综合患者症状、影像学资料以及踝关节镜下探查可以明确内踝损伤;③不同类型踝关节损伤的应对策略不同,尤其对于合并下胫腓联合损伤的踝关节骨折,三角韧带的修复是至关重要的;鉴于下胫腓螺钉固定可能出现的种种问题,学界正在探索运用三角韧带修复术替代下胫腓螺钉固定,避免二次手术和下胫腓复位不良等问题;由于三角韧带修复具有手术时间长等缺点,而suture-button固定方法也可避免下胫腓螺钉带来的一系列问题;因此临床上需要实施大样本试验,比较在下胫腓联合受损时修复三角韧带与suture-button固定的术后效果;带线锚钉技术是目前临床上修复内侧副韧带最常见的技术。

https://orcid.org/0000-0003-4445-5296 (李琪琛) 

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程

关键词: 踝关节骨折, 三角韧带损伤, 踝关节内侧稳定性, 下胫腓联合损伤, 踝关节骨性关节炎, 带线锚钉, 下胫腓螺钉

Abstract: BACKGROUND: The deltoid ligament is the most important structure to maintain the biomechanical stability of the medial malleolus. Improper handling for deltoid ligament injuries can cause traumatic arthritis and chronic ankle instability. However, there are still controversies regarding the diagnosis and treatment of ankle fractures with deltoid ligament injury. 
OBJECTIVE: To review the progress in the diagnosis and treatment of ankle fractures with deltoid ligament injury.
METHODS: PubMed, CNKI and VIP were searched for relevant articles using the keywords of “ankle, deltoid ligament, diagnosis, management” in English and Chinese, respectively. After initial retrieval, 290 articles were enrolled and finally 69 eligible articles were included for further review. 
RESULTS AND CONCLUSION: The deltoid ligament limits the valgus and external rotation of the talus and stabilizes the medial malleolus. After deltoid ligament injury, the stability of the medial malleolus is reduced, and the force line of the hind foot gradually changes. Subsequently, related deformities occur, such as flat feet, which will lead to osteochondral degeneration of the ankle joint in the long term. Medial malleolus injuries can be confirmed based on an overall consideration of patient symptoms, imaging data, and ankle arthroscopy. Different types of ankle injuries have different coping strategies. The repair of the deltoid ligament is crucially important for ankle fractures combined with distal tibiofibular syndesmosis injury. In view of the various problems that may occur in distal tibiofibular joint fixation using screws, an exploration on the use of deltoid ligament instead of distal tibiofibular joint fixation is going on, avoiding secondary operations and poor reduction of the distal tibiofibular joint. Deltoid ligament repair has the disadvantages of long operation time, and suture-button fixation method can also avoid a series of problems caused by distal tibiofibular joint fixation using screws. Therefore, large-sample clinical trials are necessary to compare the postoperative effects of deltoid ligament repair and suture-button fixation for distal tibiofibular syndesmosis injury. Anchoring technique with wire is currently the most common method for the clinical repair of the medial collateral ligament.

Key words: ankle fracture, deltoid ligament injury, medial stability of the ankle, distal tibiofibular syndesmosis injury, ankle osteoarthritis, wire anchor, distal tibiofibular screw

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