下胫腓联合损伤精准复位法的临床应用  

Clinical application of precise reduction method of inferior tibiofibular syndesmosis injury

作　　者：龚东亮 杨军 GONG Dongliang;YANG Jun(Department of Orthopedisc,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700

出　　处：《中国骨与关节损伤杂志》2024年第10期1050-1053,共4页Chinese Journal of Bone and Joint Injury

基　　金：上海市卫生健康委员会科研项目(202140522);青浦区卫生健康系统第五轮学科建设和人才培养特色项目(TX2023-02);青浦区卫生健康系统第五轮学科建设和人才培养医苑新星项目(YY2023-21);。

摘　　要：目的评估踝关节骨折合并下胫腓联合损伤切开复位内固定术中参照解剖标志点复位下胫腓联合的精准性及有效性。方法纳入自2018-06—2021-07切开复位内固定治疗的26例踝关节骨折合并下胫腓联合分离,术中显露踝关节面处可见下胫腓联合关节面对合情况,确认下胫腓联合骨性解剖标志点(下胫腓联合胫骨关节面与腓骨关节面)解剖复位,置入1或2枚下胫腓螺钉,螺钉置入第3层皮质后再部分退出至第3层皮质外,下胫腓联合处持续徒手施压状态下再将螺钉完全置入。术后通过CT评估下胫腓联合复位的精准性及有效性。结果26例均获得随访,随访时间18~36个月,平均26.5个月。术后X线片显示踝穴间隙正常,踝关节骨折对位良好,内固定在位。术后踝关节CT证实下胫腓联合关节面对位良好。踝关节骨折均骨性愈合,骨折愈合时间3~6个月,平均4.6个月。术后1年踝关节功能Baird-Jackson评分为85~100分,平均94.5分;其中优16例,良4例,可1例。结论踝关节骨折切开复位内固定术中参照下胫腓联合胫骨关节面与腓骨关节面这一解剖标志点精准复位下胫腓联合分离是一种有效、可靠的方法。ObjectiveTo evaluate the precision and effectiveness of inferior tibiofibular syndesmosis reduction guided by anatomic land marks during open reduction and internal fixation of ankle fracture complicated with lower tibiofibular union injury.MethodsA total of 26 cases of ankle fractures with inferior tibiofibular syndesmosis separation treated with open reduction and internal fixation from June 2018 to July 2021 were included.The joint face of inferior tibiofibular sundesmosis was visible at the ankle articular surface during operation,and anatomical reduction of lower tibiofibular union bone anatomical marks(articular surface of lower tibiofibular union and articular surface of fibular bone)was confirmed and 1 or 2 inferior tibiofibular screws were inserted.The screw was placed in the 3rd cortex and then partially withdrawn outside the 3rd cortex,and the screw was completely placed at the lower tibiofibular union under continuous freehand pressure.The accuracy and effectiveness of the combined lower tibiofibular reduction were evaluated by CT after operation.ResultsAll 26 cases were followed up for 18 to36 months(mean 26.5 months).Postoperative X-ray showed normal ankle mortise,good alignment of the ankle fracture,and internal fixation in place.Postoperative CT scans of the ankle joint confirmed that the inferior tibiofibular joint was facing well.The healing of fractureof ankle joint was osseous,and the fracture healing time was 3-6 months,with an average of 4.6 months.One year after surgery,the Baird-Jackson score of ankle joint function ranged from 85 to 100,with an average of 94.5 points.Among them,16 cases were excellent,4 cases were good and 1 case was fair.ConclusionOpen reduction and internal fixation of ankle fracture is effective and reliable to accurately restore the lower tibiofibular union with reference to the anatomical marks of the articular surface of tibia and the articular surface of fibula.

关 键 词：踝关节骨折 下胫腓联合损伤 解剖标志点 精准复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]