下胫腓联合损伤研究现状与治疗展望  

Current research on injury to the distal tibiofibular syndesmosis and prospects of its treatment

作　　者：尹相洁 张万魁 王鹏飞[1] 梁文杰 赵天云 Yin Xiangjie;Zhang Wankui;Wang Pengfei;Liang Wenjie;Zhao Tianyun(The First Clinical College of Gansu University of Chinese Medicine,Lanzhou 730000,China;The First Hospital of Tianshui City,Department of Orthopedics,Department of Sports Medicine,Tianshui 741000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]天水市第一人民医院骨科、运动医学科,天水741000

出　　处：《中华创伤骨科杂志》2023年第8期732-736,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：下胫腓联合损伤是踝关节损伤中常见而又容易忽视的损伤,下胫腓联合的稳定性与腓骨切迹深度相关。在影像学诊断方面,X线检查不能作为下胫腓联合损伤的确诊依据;对于>3 mm的下胫腓分离,CT扫描能准确诊断,<1 mm的分离,CT扫描并不敏感;MRI对于下胫腓联合损伤的诊断敏感度更高;关节镜技术由于其可直视的优点,逐渐被作为诊断下胫腓损伤的"金标准"。下胫腓分离发生在Lange-Hansen分型旋前外旋Ⅳ度、旋后外旋Ⅲ、Ⅳ度和旋前外展Ⅱ、Ⅲ度损伤中。多数稳定型的单纯下胫腓联合损伤非手术治疗预后良好;对于下胫腓联合不稳定或合并踝关节骨折的下胫腓联合损伤,手术解剖复位、维持下胫腓联合的稳定是基本治疗原则。螺钉固定是目前治疗下胫腓联合损伤的最常用方法,弹性固定具有能保持下胫腓联合微动关节生物特性、有较好的复位容错性、更少的并发症发生率及远期复位丢失率等优点。置钉角度是维持下胫腓良好复位的关键,但在实际操作中如何确保理论置钉角度尚缺乏具体方法描述。本文还对未来下胫腓联合损伤的治疗进行展望。Among ankle injuries,the injury to the distal tibiofibular syndesmosis is common and likely neglected.The stability of the distal tibiofibular syndesmosis is related to the depth of the fibular notch.In imaging diagnosis,X-ray examination cannot be used for a definite diagnosis of the injury to the distal tibiofibular syndesmosis.For diagnosis of the distal tibiofibular separation>3 mm,CT scan can be accurate but is not sensitive enough for a separation<1 mm while MRI is more sensitive in diagnosis of the injury.Arthroscopy has gradually been used as the"gold standard"in diagnosis of the injury to the distal tibiofibular syndesmosis due to its advantage of direct vision.The distal tibiofibular separation occurs in the injuries of pronation external rotationⅣ°,supination external rotationⅢ°andⅣ°,and pronation abductionⅡ°andⅢ°by the Lange-Hansen classification.Most patients with simple stable injury to the distal tibiofibular syndesmosis may have a good prognosis after nonoperative treatment.Surgical anatomic reduction and maintenance of stability of the distal tibiofibular syndesmosis are the basic management principles for unstable distal tibiofibular syndesmosis or the injury to the distal tibiofibular syndesmosis combined with ankle fracture.Screw fixation is the most commonly used in the surgical treatment of the injury.Elastic fixation has the advantages of maintaining the biological characteristics of the distal tibiofibular syndesmosis fretting joint,better reduction fault tolerance,and lower rates of complications and long-term reduction loss.The angle of nail placement is the key to maintaining good reduction of the distal tibiofibular syndesmosis,but there has been little description of the specific methods to ensure the theoretical angle of nail placement in practice.This article also reviews the prospects of the future treatment of the injury to the distal tibiofibular syndesmosis.

关 键 词：踝关节 创伤和损伤 骨折固定术 内 下胫腓联合 

分 类 号：R683[医药卫生—骨科学]