下胫腓联合损伤的诊断及治疗进展

Advanced progress of dignosis and treatment on distal tibiofibular syndesmosis injury

下胫腓联合损伤是一种常见的踝部损伤,通常发生在旋前-外旋和旋前-外展型踝关节骨折脱位,少部分发生在旋后-外旋型踝关节骨折脱位,也可能单独发生不伴有骨折脱位。按其损伤程度分为3型:Ⅰ型为单纯扭伤无下胫腓分离,Ⅱ型为潜在性分离,Ⅲ型为明显的分离。对于不伴有骨折和内侧结构损伤,没有造成下胫腓分离的韧带扭伤,即下胫腓联合稳定可采用保守治疗。对于伴有骨折和内侧结构损伤,下胫腓联合不稳定的病例应积极手术治疗。下胫腓联合可采用螺钉、下胫腓钩、钩板或缝扣固定,以防踝关节不稳定造成疼痛和创伤性关节炎。

Distal tibiofibular syndesmosis injury is a common ankle injury,it usually occur in pronation-external rotation and pronation-external abduction fracture-dislocation of ankle joint and partly occur in supination-external rotation fracture-dislocation of ankle joint. It may occur alone without fracture-dislocation. It was divided into 3 types according to degree of injury, type Ⅰ ： simple sprain of syndesmosis without diastasis of tibiofibular syndesmosis;type Ⅱ ： latent diastasis of tibiofibular syndesmosis;type it ：obvious diastasis of tibiofibular syndesmosis. For the patients, simple sprain of syndesmosis without fracture-dislocation （distal tibiofibular syndesmosis have stability） ,we can treat with conservative method. For the patients, distal tibiofibular syndesmosis injury combined with fracture-dislocation,which is instability, we should treat it with operative therapy. Distal tibiofibular syndesmosis injury can adopt lag screw, hook of distal tibiofibula, hook-plate or button-tuture to fixation preventing pain and traumatic arthritis cause by ankle instability.