摘要
目的不合并骨折的下胫腓分离是一种很少见的损伤，偶有报道，对于仅有内踝和（或）后踝骨折，但无外踝骨折的下胫腓分离，在临床治疗中更容易被漏诊、忽视，本研究报道一组无外踝骨折的下胫腓分离病例，探讨其损伤机制、诊断及治疗。方法9例患者，平均28.2岁，合并后踝骨折的5例，无后踝骨折的4例；合并内踝骨折的4例，无内踝骨折的5例；合并三角韧带损伤的7例，无三角韧带损伤的2例；不合并任何骨折的3例。腓骨全长没有骨折。术中外翻外旋应力下确定有下胫腓分离。除1例下胫腓用术后外固定治疗外，其他患者的下胫腓分离均在透视下闭合复位，用1～2枚下胫腓螺钉固定。结果平均随访87.9个月（32～131个月）。除1例在长时间行走后内踝处偶有疼痛，其他患者均没有疼痛。患侧踝关节背伸平均为14.4°（10°～20°），平均较健侧差5.6°（0～20°）；踝关节跖屈平均为56.7°，平均较健侧差3.3°（0～10°）。Philips and Schwartz评分平均为93.3分（86～96分）。结论无腓骨骨折的下胫腓分离是一类特殊的踝关节损伤。早期诊断非常重要，应力试验是诊断的关键。建议手术治疗。正确诊断、适当治疗及康复，能让患者得到很好的功能恢复。
Objective Compare with the rare incidence of distal tibiofibular syndesmosis diastasis without any fracture, the incidence of distal tibiofibular syndesmosis diastasis associated with medial or/and posterial malleolus but without fibular fracture may be a little bit more common but offen missed diagnosis. These two can be treated as one special kind of ankle joint injury, which can be called as ‘distal tibiofibular syndesmosis diastasis without lateral malleolus fracture’. This study focus on the patients suffered from distal tibiofibular syndesmosis diastasis without ateral malleolus fracture, discussed the mechanism, diagnosis and proper treatment methods.MethodIt was a retrospective study of nine such kind of patient, the average age is 28.2 years old. Three cases without any fracture. Five of them were associated with posterial malleolus fracture, the other four were not. Four cases were associated with medial malleolus fracture, the other five were not. Seven of them were associated with deltoid ligament rupture, the other two were not. The diagnosis depend on stress test under anesthesia.In addition to one case was treated by external fixation postoperatively,we obtained reduction under fluoroscopy in eight cases,and one to two screws were fixed the syndesmosis.ResultThe average follow up was 87.9 months （32~131 months）. One case complained occasional pain. The mean degree of dorsiflexion was 14.4°（10°~20°）, with 5.6°（0~20°） less than the normal side, the mean degree of plantar flexion was 56.7°, with 3.3°（0~10°） less than the normal side. The mean Philips and Schwartz score was 93.3 （86~96）.ConclusionIt is a special kind of ankle joint injury that distal tibiofibular syndesmosis diastasis without lateral malleolus fracture. The stress test under anesthesia is very important to the early diagnosis.Surgical treatment is always suggested. The correct diagnosis, porper treatment and rehabilitation could benefit to the patients’ functional recovery.
作者
李庭
公茂琪
孙旭
蒋协远
杨明辉
张权
张伯松
吴新宝
王满宜
LI Ting GONG Mao-qi SUN Xu JIANG Xie-yuan YANG Ming-hui ZHANG Quan ZHANG Bo-song WU Xin-bao WANG Man-yi(Beijing Jishuitan Hospital, Beo＇ing, 100035, China)
出处
《中国医刊》
CAS
2016年第10期55-60,共6页
Chinese Journal of Medicine
基金
卫生部公益性行业科研专项项目(201302007)
关键词
踝关节骨折
下胫腓分离
外踝骨折
Ankle fracture
Diastases
Lateral malleolus fracture
