本文選題：踝關節(jié)骨折 + 三角韌帶　； 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過對踝關節(jié)骨折伴有三角韌帶損傷患者的隨訪研究,比較三角韌帶手術修復與不修復的臨床治療效果,為三角韌帶損傷的臨床治療提供參考。方法:納入2014年7月至2015年7月無錫市中醫(yī)醫(yī)院創(chuàng)傷骨科收治的踝關節(jié)骨折伴有三角韌帶損傷患者72例,分為實驗組和對照組,兩組踝關節(jié)骨折均行切開復位內固定,實驗組36例患者手術修復三角韌帶,對照組36例患者不修復。術后采用門診復查或電話回訪的方式進行跟蹤隨訪,比較兩組術中出血量、手術時間、AOFAS踝-后足評分、術后并發(fā)癥、住院時間、術后踝關節(jié)疼痛評分、內踝間隙,計量資料以均數(shù)±標準差表示并采用t檢驗,率的比較及計數(shù)資料采用χ2檢驗,以P0.05為差異有統(tǒng)計學意義。結果:(1)在研究期限內共隨訪72例患者,均為閉合性損傷,未合并其他部位骨折。受傷至手術時間3-7 d,平均4.3 d。其中實驗組男20例,占56%,女16例,占44%,左側踝關節(jié)20例,占56%,右側踝關節(jié)16例,占44%,對照組男19例,占53%,女17例,占47%,左側踝關節(jié)18例,占50%,右側踝關節(jié)18例,占50%。實驗組平均年齡(38.16±13.55)歲,對照組平均年齡(38.68±13.24)歲。(2)實驗組與對照組患者性別、年齡、損傷部位、術中出血量、術后并發(fā)癥均無統(tǒng)計學意義,實驗組平均手術時間為(113.56± 14.68)min,對照組平均手術時間為(101.32±13.96)min,用χ2檢驗得出P=0.042,P0.05,實驗組手術時間明顯長于對照組;術后3個月踝關節(jié)功能優(yōu)良率實驗組為91.7%,對照組為83.3%,術后3個月實驗組踝關節(jié)的優(yōu)良率明顯高于對照組(P0.05);實驗組平均住院時間為(16.26±3.62)d,對照組平均住院時間為(17.41±4.02)d,用χ2檢驗得出P=0.636,P0.05,實驗組住院時間與對照組無明顯差異;實驗組和對照組術后3個月踝關節(jié)疼痛評分分別為(1.06±0.25)分和(2.68±0.32)分,都明顯低于術前(6.28±0.82)分和(6.20±0.60)分,同時實驗組與對照組組間對比,術前疼痛評分P0.05,無統(tǒng)計學意義,術后P0.05,實驗組療效要好于對照組;實驗組和對照組術后3個月內踝間隙分別是(2.06±0.25)mm 和(2.68±0.32)mm,都明顯低于術前(5.12±1.20)mm 和(5.34±1.35)mm,同時術前兩組組間對比P0.05,無統(tǒng)計學意義,術后P0.05,實驗組內踝間隙要小于對照組。結論:(1)臨床上要在詳細的病史、臨床癥狀及相關體征的基礎上進行有目的地影像學檢查,以提高診斷的準確率。(2)踝關節(jié)骨折伴有三角韌帶損傷的患者,修復三角韌帶可更有效的促進患者康復,促進患者踝關節(jié)功能的恢復。(3)對于三角韌帶深層損傷的患者,本文建議首選手術以恢復三角韌帶的連續(xù)性與完整性。
[Abstract]:Objective: to compare the clinical effects of surgical repair and non-repair of triangular ligament in patients with ankle fracture associated with triangular ligament injury, so as to provide reference for clinical treatment of triangular ligament injury. Methods: from July 2014 to July 2015, 72 patients with ankle fracture associated with deltoid ligament injury in Department of Orthopedics, Wuxi traditional Chinese Medicine Hospital, were divided into experimental group and control group. The two groups were treated with open reduction and internal fixation. The experimental group (36 cases) underwent surgery to repair the triangular ligament, while the control group (36 cases) did not. The blood loss, operative time, postoperative complications, hospital stay, ankle pain score and medial ankle space were compared between the two groups by means of outpatient reexamination or telephone follow-up, and compared with those of the two groups in terms of intraoperative bleeding, AOFAS ankle-hind foot score, postoperative complications, hospitalization time, postoperative ankle pain score, and medial malleolus space. The measurement data were expressed as mean 鹵standard deviation and t test was used, and 蠂 2 test was used to compare the rate and count data. The difference was statistically significant with P0.05. Results A total of 72 patients were followed up during the study period, all of whom were closed injuries without fracture of other parts. The time from injury to operation was 3 to 7 days, with an average of 4.3 days. There were 20 males in the experimental group (56%), 16 cases in the female (44 cases), 20 cases in the left ankle joint (20 cases), 56 cases in the left ankle joint, 16 cases in the right ankle joint (44 cases), 19 cases in the control group (19 cases), 53 cases (53 cases), 17 cases (4747) in the control group, 18 cases in the left ankle joint (50%), 18 cases in the right ankle joint (50%), and 50 cases in the right ankle joint. The average age of the experimental group was 38.16 鹵13.55 years old, and that of the control group was 38.68 鹵13.24 years old. The mean operation time was 113.56 鹵14.68 min in the experimental group and 101.32 鹵13.96 min in the control group. The excellent and good rate of ankle joint function was 91.7 in the experimental group and 83.3 in the control group 3 months after operation, the excellent and good rate of the ankle joint in the experimental group was significantly higher than that in the control group 3 months after operation, the average hospitalization time of the experimental group was 16.26 鹵3.62 days, the average hospitalization time of the control group was 17.41 鹵4.02 days, 蠂 2 was used. The results showed that there was no significant difference in the length of hospitalization between the experimental group and the control group. The scores of ankle joint pain in experimental group and control group were 1.06 鹵0.25 and 2.68 鹵0.32 respectively, which were significantly lower than those before operation (6.28 鹵0.82) and 6.20 鹵0.60 (P < 0.05). After operation, the curative effect of the experimental group was better than that of the control group, the malleolus space of the experimental group and the control group were 2.06 鹵0.25)mm and 2.68 鹵0.32 mm respectively within 3 months after operation, which were significantly lower than those before operation (5.12 鹵1.20)mm and 5.34 鹵1.35mm), and there was no significant difference between the two groups before operation (P 0.05). The medial malleolus space in the experimental group was smaller than that in the control group (P 0.05). Conclusion 1) in order to improve the diagnostic accuracy of patients with ankle fracture associated with triangular ligament injury, we should carry out purposeful imaging examination on the basis of detailed medical history, clinical symptoms and related signs in order to improve the diagnostic accuracy. Repair of triangular ligament can promote the recovery of patients more effectively, promote the recovery of ankle function.) for the patients with deep deltoid ligament injury, we suggest that the first choice of surgery to restore the continuity and integrity of the triangular ligament.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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