胫腓下联合分离伴踝部骨折的治疗  

Management of syndesmosis diastasis with anMe fraction

作　　者：徐永强 王龙滨 蒋建新[2] 

机构地区：[1]上海市市北医院骨科,200435 [2]上海交通大学附属第六人民医院骨科,200233

出　　处：《美中国际创伤杂志》2005年第3期13-14,17,共3页U.S.Chinese International Journal of Traumatology

摘　　要：目的：探讨踝关节损伤时胫腓下联合分离的机制及胫腓下联合固定的利弊。方法：伴胫腓下联合分离的踝天节损伤共31例，其中19例未行胫腓下联合分离固定，10例用螺钉困定胫腓下联合，2例用下胫腓钩固定。内踝骨折以螺钉或张力带钢丝固定。外踝以螺钉或钢板固定，后踝用松质骨螺钉加压固定。结果：胫腓下联合固定患者中2例松动，2例术后1～2年取出固定螺钉，其余10例均6～12周取出胫腓下联合固定螺钉。未发生胫腓下联合螺钉断裂。内外踝及后踝骨折内固定于6～29个月取出。未行胫腓下联合分离固定的病例均未出现胫腓下联合分离。结论：胫腓下联合的稳定性不仅仅取决于胫腓下联合本身，胫腓下联合韧带损伤时，只有同时伴有踝关节内侧骨韧带复合体损伤，才会出现临床上的胫腓下联合分离，因此踝关节骨折脱位时，只要内外踝或后踝解剖复位，固定，牢固，胫腓下联合分离即可自动复位，一般不必做胫腓下联合的固定。Objective： To study the mechanism of sprained ankle with syodesmosis diastasis and the advantages and disadvantages of internal fixation with svndesmosis screw. Methods： This retrospective study was conducted on a total of 31 eases of fraetured ankles with syndesmosis diastasis. For distal tihiofibutar syndesmosis diastasis, serew transfixation was performed on 10 cases and syndesmotic hook was used on 2 cases, the rest 19 patients did not use any standard syndesmotic screws. Besides, fixation with screws or wire for medial malleolus fracture, screws or plates for lateral malleolus fracture, cancellated bone screws for ventral condyle fracture. Results： For patients with syndesmosis fixation, there was no breakage of screws noted except 2 cases of screw loosening. For patients without syndesmosis fixation, no separation of syndesmosis was noted. Conclusion： If ankle joints （medial and lateral malleolus or ventral condyle） is anatomically redueted and securely fixed, and the deltoid ligament complex is intact, syndesmotic screw fixation is generally not required for maintaining the integrity of the tibiofibular joint.

关 键 词：踝关节 胫腓下联合 分离 固定 稳定性 

分 类 号：R683.42[医药卫生—骨科学]