慢性下胫腓联合损伤的诊治进展

Management of chronic injury of distal tibiofibular syndesmosis

慢性下胫腓联合损伤是急性损伤诊治不当而迁延不愈的结果。急性下胫腓联合损伤通常合并踝关节骨折,当骨折开始愈合后,慢性下胫腓联合损伤的症状逐渐表现出来,此时结合其体征、X线片,必要时拍摄外旋或外翻应力位X线片、踝关节CT或MRI,其诊断稍显复杂但并不困难。踝关节镜检查为诊断慢性下胫腓联合损伤提供直接证据。由于认识不足,其治疗手段五花八门,目前尚无金标准。下胫腓韧带重建术与下胫腓融合术是两大类理念不同的治疗方法,尽管从短期随访来看,二者都取得了不错的临床结果,但后者仍颇具争议。本文将系统阐述慢性下胫腓联合损伤的诊断方法,并通过文献综述,批判性地总结现有的治疗理念。

Chronic injury of distal tibiofibular syndesmosis is the result of improper management of acute injury of the syn- desmosis. Acute syndesmotic injury is often accompanied by ankle fractures. As ankle fractures are healing, the symptoms of chronic syndesmotic injury begin to appear. With manual stress test, plain radiographs, and CT or MRI when necessary, the di- agnosis seems a little complex but not difficult. Arthroscopic findings are the direct evidence of chronic syndesmotic injury. Be- cause of insufficient recognition to this injury, the treatment techniques vary considerably without a golden standard for the treat- ment. Distal tibiofibular ligaments reconstruction and distal tibiofibular arthrodesis are the two main treatment strategies, while the latter one is still controversial, though the short-term follow-up has shown a good result. This paper is going to elaborate the diagnosis of chronic syndesmotic injury systematically and summarize the treatment concepts critically through a literature re-view.