胫腓下联合分离伴踝部骨折的治疗

Treatment of Distal Tibiofibular Syndesmosis Diastasis and Fractures of Ankle

目的探讨踝关节损伤时胫腓下联合分离的机制及胫腓下联合固定的利弊.方法伴胫腓下联合分离的踝关节损伤共31 例,其中19 例未行胫腓下联合分离固定,10 例用螺针固定胫腓下联合,2 例用下胫腓钩固定.内踝骨折以螺钉或张力带钢丝固定.外踝以螺钉或钢板固定,后踝用松质骨螺钉加压固定.结果胫腓下联合固定患者中2 例松动,2 例术后1～2 a取出固定螺钉,其余10 例均6～12周取出胫腓下联合固定螺钉.未发生胫腓下联合螺钉断裂.内外踝及后踝骨折内固定于6～29个月取出.未行胫腓下联合分离固定的病例均未出现胫腓下联合分离.结论胫腓下联合的稳定性不仅仅取决于胫腓下联合本身,胫腓下联合韧带损伤时,只有同时伴有踝关节内侧骨韧带复合体损伤,才会出现临床上的胫腓下联合分离,因此踝关节骨折脱位时,只要内外踝或后踝解剖复位,固定牢固,胫腓下联合分离即可自动复位,一般不必做胫腓下联合的固定.

Objective： To appraise the advantages and disadvantages in the treatment of distal tibiofibular syndesmosis diastasis with syndesmosis screw. Methods Thirty-one cases of ankle fractures combined with distal tibiofibular syndesmosis diastasis were studied retrospectively. Among them, 12 cases were fixated the separation of syndesmosis with screws or syndesmotic hooks, and the rest of 19 cases were not fixated. Results None of the patients without distal tibiofibular syndesmosis diastasis fixation had significant unstable syndesmosis. In two cases of fixation, the screws loosed. In 10 patients of fixation, the screws and syndesmotic hooks were removed at 6- 12 weeks after operation. Conclusion If medial and lateral joint fixation is rigid anatomically and the deltoid ligament complex is intact, syndesmotic screw fixation is generally not necessary for maintaining the integrity of the tibiofibular joint.