皮质骨螺钉内固定治疗下胫腓联合分离的CT研究

Internal fixation with cortical bone screws for the treatment of distal tibiofibular syndesmosis separation: a CT study of 32 patients

目的：探讨皮质骨螺钉内固定对下胫腓联合的影响。方法：回顾性分析32例行皮质骨螺钉内固定术治疗的下胫腓联合分离患者的临床资料，男18例、女14例。年龄28～64岁，中位数43．5岁。左侧14例，右侧18例。按照 Danis －Weber 分型，B 型12例、C 型20例。腓骨骨折合并后踝和内踝（或三角韧带）损伤11例，腓骨骨折合并内踝（或三角韧带）损伤21例。所有患者均摄健、患侧下胫腓骨横断位 CT 片，在 CT 片上测量胫腓骨适合角、胫骨腓切迹与腓骨的相对外移距离和相对后移距离，并对其进行比较分析。结果：患侧胫腓骨适合角、胫骨腓切迹与腓骨的相对外移距离均小于健侧[68．66°±9．28°;，79．49°±14．66°;，t ＝2．998，P ＝0．025；（5．65±1．79）mm，（7．66±2．05）mm，t ＝2．131，P ＝0．012]，而胫骨腓切迹与腓骨的相对后移距离大于健侧[（4．94±1．49）mm，（1．90±3．34）mm，t ＝14．089，P ＝0．002]。结论：皮质骨螺钉内固定治疗下胫腓联合分离后，患侧下胫腓联合较健侧有向前内侧旋转的趋势。

Objective：To explore the effect of internal fixation with cortical bone screws on the distal tibiofibular syndesmosis. Methods：The clinical records of 32 patients who were treated with cortical bone screws internal fixation for distal tibiofibular syndesmosis were analyzed retrospectively.The patients consisted of 18 males and 14 females,and ranged in age from 28 to 64 years （Median =43.5 yrs）.The distal tibiofibular syndesmosis separation located in left leg for 14 cases and right leg for 18 cases.According to the Danis -Weber classification,the injuries belonged to types B（12）and C（20）.Fibula fracture combined with posterior malleolus injury and medial malleolus injury or deltoid ligament injury were found in 11 patients,and fibula fracture combined with medial malleolus injury or deltoid ligament injury were found in 21 patients.Bilateral distal tibiofibular transverse CT films were taken in all patients.The tibiofibula congru-ence angle,fibular outward displacement and backward displacement relative to peroneal sinus of tibia were measured on the CT films and were analyzed.Results：The tibiofibula congruence angle and fibular outward displacement relative to peroneal sinus of tibia of affected side were less than those of uninjured side（68.66 ±9.28 vs 79.49 ±14.66 degrees,t =2.998,P =0.025;5.65 ±1.79 vs 7.66 ±2.05 mm,t =2.131,P =0.012）,while fibular backward displacement relative to peroneal sinus of tibia of affected side was greater than that of uninjured side（4.94 ±1.49 vs 1.90 ±3.34 mm,t =14.089,P =0.002）.Conclusion：After cortical bone screws internal fixa-tion for the treatment of distal tibiofibular syndesmosis separation,there is a trend for anteromedial rotation of distal tibiofibular syndesmosis of affected side compared to uninjured side.