目的：踝关节骨折合并三角韧带损伤，是否需要修补，这些年来一直存在争议。目前已经有很多的研究认为只要解剖复位外踝、后踝骨折，复位下胫腓及踝穴，三角韧带即可自然愈合。但这些多为病例报告。本研究通过临床对比研究，对比三角韧带修补和不修补的手术治疗的踝关节骨折的临床结果，以进一步探讨踝关节骨折合并的三角韧带损伤是否需要修补。

方法：手术治疗71位合并三角韧带损伤的踝关节骨折患者，平均随访31个月。其中33位一期行三角韧带修补，38位未行修补。所有病人在术中均在透视下行应力试验验证是否有三角韧带损伤及治疗后的稳定性。

结果：最终随访时，所有骨折均愈合，患者没有明显的疼痛。修补组跖屈平均50°，比健侧平均差2.5°（0-10°）；背伸平均14.5°，比健侧平均差7°（0-20°）。未修补组修补组跖屈平均48.8°，比健侧平均差2.8°（0-10°）；背伸平均15.4°，比健侧平均差6.6°（0-20°）。最终随访时，未修补组有一位患者出现踝关节轻度退行性变。修补组Philips评分平均为92.5（80-100）分，未修补组Philips评分平均为93.4（85-100）分。两组间的活动度、评分的差异均没有统计学的显著性。根据术中应力试验，我们发现三角韧带修补能有较好的早期稳定作用，可以减少距骨在应力下的倾斜。

结论：由于三角韧带修补和不修补的临床结果相当，本研究不支持三角韧带损伤需要常规一期显露和修补。修补三角韧带可能对距骨的早期稳定性有一定帮助，但远期结果需要进一步研究。

Purpose: 20 years ago, it was common for surgeons to repair the injured deltoid ligaments at the time of fibular osteosynthesis. Then, anatomic restoration of the fibular fracture and the medial clear space without direct surgical intervention of the injured deltoid ligaments grew common. But, it was supported mostly by case series reports. The controversy has never been stopped. This study compared the clinical outcomes in patients with repairing the injured deltoid ligaments and patients without direct surgical intervention after anatomic restoration of the fibular fracture and the medial clear space.

Method: 71 patients were followed up for average 31 months, who were diagnosed as ankle fractures associated with deltoid ligament rupture and later dislocation of talus. Among them, 33 patients were treated by deltoid ligament repairing at the time of fibular (and posterior malleolus, sometimes) osteosynthesis, 38 patients accepted no direct surgical intervention to the deltoid ligaments after anatomic restoration of the fibular fracture and the medial clear space. All the patients were evaluated with stress views intraoperatively. The outcomes were evaluated with Philips and Schwartz clinical scoring system of ankle.

Results: All fractures were healed without pain. In the  repairing group, the mean degree of plantar flexion was 50°,with 2.5°（0-10°）less than the normal side, the mean degree of dorsiflexion was 14.5°,with 7°（0-20°）less than the normal side.  In the non-repairing group,  the mean degree of plantar flexion was 48.8°,with 2.8°（0-10°）less than the normal side, the mean degree of dorsiflexion was 15.4°,with 6.6°（0-20°）less than the normal side.  There were no degenerative changes in all ankles. The mean Philips and Schwartz score was 92.5(80-100) in the repairing group vs. 93.4 (85-100) in the non-repairing group. No statistically significant inter-group differences were evident in terms of clinical outcomes. According to the intraoperative stress views, we found that repairing of injured deltoid ligaments can reduce the talus tilt under valgus and lateral rotational stress.  However, No statistically significant inter-group differences were evident in terms of clinical outcomes.

Conclusion: This study did not support regularly exposing and repairing the injured deltoid ligaments, since both repairing and non-repairing achieved similar results. Repairing injured deltoid ligaments may be helpful to early talus stability postoperatively.