下胫腓关节分离的诊断及手术治疗

Diagnosis and operative treatment of separation of Jower tibiofibular joint

目的 正确诊断及治疗下胫腓关节分离,恢复踝关节的生理功能。方法 63例病人全部手术治疗,踝关节骨折使用螺丝钉、克氏针、张力带或普通钢板固定。分离的下胫腓关节用长螺丝钉、松质骨螺钉或骨螺栓固定。结果 随访时间1—5年,优38例,良18例,可5例,差2例,优良率为88.9％。结论 应力位或双踝关节对比摄X线片,可避免下胫腓关节分离的漏诊;按照Davis—Weber和Lauge—Hansen分类标准进行分类,可指导临床做出正确的治疗方案;固定时保持踝关节于中立位,术中应注意下胫腓关节固定的松紧度,外踝骨折必须做到解剖复位,以维持踝穴的正常宽度;内固定物应尽早取出,有利于踝关节功能的恢复。

Objective To correctly diagnose and treat the separation of the lower tibiofibular joint, and to recover the physiological function of injured joint. Methods 63 patients were performed on operative treatment, the ankle joint fractures had been fixed with screw, kirschner pin, tension band or ordinary joint-bone plate. The separated tibiofibular joint had been fixed with long screw, cancellous bone screw or bolt. Results 63 cases were followed-up from 1 to 5 years, 38 cases were excellent, 18 cases were good, 5 cases were improve and 2 cases were poor, the total responsive rate were 88. 9%. Conclusion 1. The injured joint x-raied in stress situation or contrasted with another joint, misdiagnosis could be avoided. 2. According to Davis-weber and lauge-Hansen classification, the therapeutic plan can be drown up adequately. 3. keeping the ankle joint in neutral position;adjusting the tinghtness of the fixation, reducting the fracture to anatomy position, removing the internal fixation objects early, all these methods are benifical to recovering the injury.