Endobutton装置治疗单纯下胫腓联合分离

Treatment of tibiofibular diastasis without ankle fracture with Endobutton device

目的:探讨Endobutton装置治疗单纯下胫腓联合分离的临床疗效。方法:2009年1月至2011年1月,对采用Endobutton装置固定治疗的8例单纯下胫腓联合分离进行连续随访,其中男6例,女2例;年龄25～44岁,平均34岁。对有踝关节损伤病史及踝部出现疼痛、红肿、踝关节周围瘀斑的患者常规行影像学检查以明确诊断,并予以手术治疗。手术前后X线测量:①内踝关节面与距骨关节面的间隙;②胫骨前结节与腓骨的重叠阴影;③下胫腓联合间隙3项指标,并结合Baird-Jackson评分标准评估其临床疗效。结果:本组均获随访,时间6～24个月,平均12个月。术前正侧位下胫腓联合重叠影(3.83±0.37)mm,下胫腓联合间隙(7.90±0.22)mm,胫距关节内间隙(5.08±0.34)mm;术后下胫腓联合重叠影(7.46±0.14)mm,下胫腓联合间隙(3.39±0.07)mm,胫距关节内间隙(3.16±0.07)mm,与术前比较差异均有统计学意义(P<0.01)。末次Baird-Jackson评分(94.63±3.66)分,优6例,良1例,可1例。结论:Endobutton装置治疗单纯下胫腓联合的手术方法具有创伤小、操作简捷、无须再次取出内固定、可较好恢复踝关节功能、减少相关并发症等优势,可广泛推广应用于临床。

Objective：To investigate the clinical effects of Endobutton device in the treatment of tibiofibular diastasis without ankle fracture. Methods：From January 2009 to January 2011,a total of 8 patients with tibiofibular diastasis without ankle fracture were treated with Endobutton device. There were 6 males and 2 females with an average age of 34 years（ranged,25 to 44 years）. All the patients with ankle injured history and ankle pain,swelling,ecchy-mosis were diagnosed by radiology and then operated with Endobutton device. The clinical effects were evaluated according to Baird-Jackson scoring system and radiological evaluated parameters comprised of tibiofibular overlap,total clear space and medial clear space. Results：All the patients were followed up,and the duration ranged from 6 to 24 months,with an average of 12 months. Radiographic results were detailed as follows：tibiofibular overlap averaged （3.83±0.37） mm in preoperative and （7.46±0.14） mm in postoperative;mean total clear space（7.90±0.22） mm in preoperative and（3.39±0.07） mm in postoperative;medial clear space averaged（5.08±0.34） mm in preoperative and（3.16±0.07） mm in postoperative. There was significant difference above data between preoperative and postoperative one. The lastest Baird-Jackson score results：6 cases obtained an excellent result,1 good and 1 fair. The main score was （94.63±3.66）. Conclusion：Endobutton device for the treatment of tibiofibular diastasis without ankle fracture has advantages such as simple and minimally invasive,no need of second operation for implant removal,recover the ankle function better and less complications,which should be popularized and applied to clinical widely.