不稳定性下胫腓联合损伤的诊治研究进展  

Recent advances in the diagnosis and treatment of instable distal tibiofibular syndesmosis injuries.

作　　者：邢丹[1] 宋东辉[1] 马信龙[1] 马剑雄[2] 

机构地区：[1]天津市公安医院骨科,300042 [2]天津医科大学总医院骨科生物力学实验室

出　　处：《中国骨与关节杂志》2013年第7期414-418,共5页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金项目(81102607);天津市科技支撑重点项目(11ZCGYSY01800);天津市卫生局科技攻关项目(11KG137)

摘　　要：<正>下胫腓联合也称下胫腓关节,属于纤维连接关节,其关节面通过韧带相连~[1]。下胫腓联合是一个由多条韧带组成的复合结构,为下胫腓关节提供了一定的稳定性。它的组成包括下胫腓前韧带、下胫腓后韧带、下胫腓横韧带以及骨间韧带。虽然有学者认为下胫腓联合包括下胫腓横韧带,但多数情况下认为其是下胫腓后韧带的延续~[2]。下胫腓联合的损伤多由外旋应力所致,见于部分WeberSyndesmosis is a kind of fibrous articulation in which the opposing joint surfaces are united by ligaments. The distal tibiofibular syndesmosis consists of a complex of ligaments that provide stability to the joints. The anterior, posterior and transverse tibiofibular ligaments together with the interosseous ligament form the distal tibiofibular syndesmosis. Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. It is estimated that 10% of all ankle fractures and 20% of operatively treated ankle fractures are accompanied by syndesmotic injury. Distal tibiofibular syndesmotie ligament injury can also occur in isolation mostly due to an extorsion or in association with damage to the lateral ankle ligaments. Syndesmotic injury leads to subsequent mortise instability and should be treated with syndesmotic stabilization to prevent long-term complications of ankle joint. Immediate reconstruction of the unstable syndesmosis is indicated, because a delay could expedite the development of degenerative arthritis. However, the precise diagnosis of distal tibiofibular syndesmotic ligament injury is critically difficult. The distinction should be made between syndesmotic ligament disruption and real syndesmotic instability. Radiographic measures including tibiofibular overlap, tibiofibular space, medial and superior space are of little value in detecting distal tibiofibular syndesmosis, because all these parameters depend on the rotation of the ankle joint. CT and MRI could also be used in detecting syndesmotic disruption in patients with distal tibiofibular syndesmotic ligament injuries. Intra-operative stress testing is essential in the diagnosis for syndesmotic injuries. Although ankle arthroscopy is a more sensitive method than radiography, it is more invasive and not all surgeons have the expertise to perform ankle arthroscopy. Therefore, there has no ＂gold standard＂ diagnostic measure in testing the instability of distal tibiofibular syndesmotic ligament injuries. Furthermore, the nee

关 键 词：Joint instability DIAGNOSIS THERAPY Tibia-fibula joints 

分 类 号：R683.4[医药卫生—骨科学] R687.3[医药卫生—外科学]