中西医结合诊断治疗下胫腓前韧带损伤概况

下胫腓前韧带损伤可单发也可合并骨折，是踝关节损伤诊疗的难点和重点，未合并骨折时往往被误诊和漏诊，需与外踝骨折、腓骨长短肌腱滑脱鉴别。踝关节解剖特点为关节囊前、后壁薄弱、松弛，距骨滑车前宽后窄；当踝关节受伤至外侧韧带断裂或外踝骨折时，只有在内侧三角韧带同时断裂时踝关节才会出现明显不稳现象。可归属于中医筋伤范畴，下胫腓前韧带损伤也被称为“踝缝伤筋”。现代医学认为系外旋暴力所致。按损伤程度、姿态分类；诊断可通过临床及X线；常规X线难以确诊又高度怀疑，可拍健侧对比；MRI和关节镜可明确诊断。治疗原则是复位和固定，早期以中医保守治疗为主，可冰敷，损伤轻微可理筋手法，消肿止痛，按压商丘、解溪、昆仑、足三里等穴，以通经络之气；中晚期应考虑手术治疗；密切关注术中、术后及保守治疗并发症。中医药治疗注意辨证分型。

Chinese and Western Medicine Diagnosis and Treatment of Anterior Lower Tibiofibular Ligament Injury

The anterior inferior tibiofibular ligament injury can be single can also be combined with fracture, is the emphasis and difficulty in diagnosis and treatment of ankle joint injury, is often misdiagnosed with no fracture, and fracture of lateral malleolus, the peroneal tendon slip differential. Ankle anatomy characteristics before the joint capsule, the rear wall is weak, relaxation, trochlea of talus widened; when the ankle injury to the lateral ligament rupture or lateral malleolar fractures, fracture and only in the deltoid ligament ankle will appear obvious instability phenomenon. Chinese medicine can be attributed to the category of tendon injury, anterior lower tibiofibular ligament injury is also known as the ＂ankle joint sprain＂ . Western medicine thinks, external rotation caused by violence. According to the classification of injury degree, attitude ; diagnosis by clinical and X-ray examination; X-ray diagnosis is difficult and highly suspected, may make the healthy side comparison of MRI and arthroseopy in diagnosis. The treatment principle is reduction and fixation, early in the traditional Chinese medicine conservative treatment, can be icing, slight injury to manipulation, acetanilide detumescence, press Shangqiu, JieXi, Kunlun, Point Zusanli, main and collateral channels to pass gas ; advanced should consider the operation treatment; pay close attention to intraoperative, postoperative complications and conservative treatment. Chinese medicine treatment of attention to syndrome differentiation typing.