下胫腓联合分离的手术治疗

Surgical Treatment of the Disruption of Inferior Tibiofibular Joint

目的探讨下胫腓联合分离的对踝关节的影响,比较分析下胫腓联合分离的手术方法。方法自1997年7月～2002年7月共收治下胫腓分离87例,合并踝部骨折69例。手术方法有:①单纯下胫腓联合复位,松质骨钉内固定,石膏托外固定(37例);②腓骨骨折钢板螺丝钉固定,经钢板松质骨钉固定下胫腓联合(34例);③下胫腓联合分离复位,取部分腓骨长肌腱修复下胫腓联合韧带,松质骨钉内固定,石膏托外固定(16例)。结果本组87例获2年以上的随访,优55例(63%),良18例(21%),可14例(16%),差0例(0%)。结论下胫腓联合对维持踝穴的完整及稳定具有重要意义,需根据不同的病情选择合理的手术方法。采用腓骨长肌腱修复下胫腓韧带术治疗是非常有效的。

Objective To study the influence of inferior tibiofibular joint disruption on ankle function and decide the rational fixation method.Methods From July 1997 to July 2002,87 patients suffered from the disruption of inferior tibio-fibular joint were treated,69 of them combined with ankle fractures.The following methods were used:①The simple disruption of tibio-fibular joint was restored and fixed with cancellous bone screw (n=37).②Fibular fractures were fixed with plates and inferior tibiofibular joint were fixed with cancellous bone screw (n=34);③The injury of inferior tibiofibular ligaments was repaired with the tendon of peroneus longus,and the inferior tibiofibular joint was fixed with cancellous bone screw(n=16).Results The patients were followed up at least for two year.The curative effects were assessed according to the complaints of patients,the function of ankle and X-ray figures.Fifty five patients were rated excellent,18 were good and 14 were fair.Conclusion The repair of inferior tibio-fibular ligaments with the tendon of peroneus longus is an excellent way to treat complete disruption of inferior tibiofibular joint.