关键词: 踝关节骨折, 下胫腓联合, 外踝固定, 三角韧带, 视觉模拟量表, 踝关节活动度, 并发症

Abstract: Objective To investigate the effect of lateral malleolus and lower tibiofibular joint fixation + triangular ligamentous anchor fixation on ankle fracture (AF) with inferior tibiofibular union separation.Methods A total of 103 patients with AF combined with inferior tibiofibular union separation treated in our hospital from September 2020 to June 2023 were retrospectively selected.Among them,51 patients with lateral malleolus and lower tibiofibular joint fixation + triangular ligament anchor repair were used as the fixed repair group,and 52 patients with lateral malleolus and lower tibiofibular joint fixation were used as the fixed group.The surgical status and complications were compared between the two groups,as well as the VAS score,ankle range of motion,AOFAS score,KAFS score,the excellent and good rate of AOFAS ankl-hind foot score before and after surgery.Results The operation time of the fixed repair group was (97.19±10.31) min,which was longer than (64.92±9.75) min of the fixed group,and the intraoperative blood loss was (104.00±15.48) ml,which was higher than (68.15±17.23) ml of the fixed group，the differences between the two groups were statistically significant (P<0.05).There was no significant difference in hospitalization time and fracture healing time between the two groups (P>0.05).The VAS scores of the fixed repair group at 1 month and 3 months after operation were (3.06±1.00) scores and (2.05±0.51) scores,which were lower than (4.14±0.76) scores and (2.72±0.69) scores of the fixed group，the differences between the two groups were statistically significant (P<0.05).The ankle joint mobility of the fixed repair group was (46.28±4.17)° and (54.24±3.18)° at 3 months and 6 months after operation,which was higher than that of the fixed group (41.59±3.88)° and (50.13±2.65)°,the AOFAS ankle-hind foot scores were (75.68±3.79) scores and (88.16 ± 2.52) scores,which were higher than those of the fixed group (70.04±4.25) scores and (83.15±2.70) scores,the KAFS scores were (74.99±4.23) scores and (87.13±3.00) scores,respectively,which were higher than (70.01±3.44) scores and (82.04±4.35) scores in the fixed group,the differences between the two groups were statistically significant (P<0.05).At 6 months after operation,48 cases were excellent and 3 cases were good of AOFAS ankle hindfoot score in the fixed repair group,34 cases were excellent,12 cases were good and 6 cases were fair in the fixed group,the fixed repair group was better than the fixed group,and the differences between the two groups were statistically significant (P<0.05).The incidence of complications in the fixed repair group was 1.96% lower than that in the fixed group (15.38%),and the difference between the two groups was statistically significant(P<0.05).At 6 months after operation,the AOFAS anklehind foot score was excellent in 48 cases and good in 3 cases in the fixed repair group,and excellent in 34 cases,good in 12 cases and fair in 6 cases in the fixed group.The fixed repair group was better than the fixed group (P<0.05);the incidence of complications in the fixed repair group was 1.96% lower than that in the fixed group (15.38%) (P<0.05).Conclusion Compared with lateral malleolus and lower tibiofibular joint fixation,lateral malleolus and lower tibiofibular joint fixation + triangular ligament anchor repair is used to treat AF patients with inferior tibiofibular union separation.Although it can prolong the operation time and increase the amount of bleeding,it can reduce the pain of patients,improve ankle function and reduce the risk of complications.

Key words: ankle joint fracture, inferior tibiofibular union, fixation of lateral ankle, triangular ligament, visual analog scale, ankle joint mobility, complication