踝关节骨折合并下胫腓韧带损伤的治疗

目的：探讨合并下胫腓韧带损伤的踝关节骨折手术与非手术治疗的效果。方法回顾性分析72例合并下胫腓韧带损伤的踝关节骨折患者的资料,测量治疗后内踝与距骨间隙宽度、胫腓间隙宽度与后踝骨折块移位程度等。结果随访10个月~3年,手术治疗组优良率92.3%,非手术治疗组81.8%（P＜0.05）;手术治疗组胫腓间隙宽度、后踝骨折块移位程度及Olerud评分、Tegner评分、疼痛评分优于非手术组（P＜0.05）。结论合并下胫腓韧带损伤的踝关节骨折,应尽量接受手术治疗。     

合并前胫腓韧带损伤的WeberB型踝关节骨折的手术治疗

目的：评价合并前胫腓韧带损作的WeberB型踝关节骨折手术治疗效果。方法：对32例合并前胫腓韧带损伤的WeberB型骨折进行手术治疗。结果：32例病人均获得随访（1.2-3.9年），平均2.8年，根据Meyer和Kumler的临床评价标准以及Leeds和Ehrlich的X线片段标准进行评价，优良率达94％。结论：合并前胫腓韧带损伤，特别是伴前胫腓韧带撕脱性骨折的WeberB型骨折，手术治疗能获得满意疗效。     

合并下胫腓韧带损伤的踝关节骨折的治疗

目的探讨切开复位内固定治疗合并下胫腓韧带损伤的踝关节骨折的疗效。方法 54例合并下胫腓韧带损伤的踝关节骨折的患者分别接受切开复位、闭合复位治疗,术后定期随访,测量胫腓间隙宽度、内踝与距骨间隙宽度、后踝骨折块移位程度等。按Olerud评分、Tegner评分、疼痛评分系统评价术后踝关节的主观感受、日常生活功能及疼痛状况。结果手术组患者术后胫腓间隙宽度、后踝骨折块移位程度及Olerud评分、Tegner评分、疼痛评分与闭合复位组比较,效果较好（P〈0.05）,差异有统计学意义;内踝与距骨间隙宽度效果相似,差异无统计学意义。结论手术组术后踝关节解剖位置和患者主观功能感受均较闭合复位组好,切开复位内固定是治疗合并下胫腓韧带损伤的踝关节骨折的一种有效方法。     

踝关节骨折伴下胫腓关节分离的治疗

目的 探讨踝关了骨折伴下胫腓关节分离的治疗方法。方法 对２０例踝关节骨折伴下胫腓韧带分离患者按Ｂｏｎｎｉｎ分度法,Ⅱ１２例,Ⅲ度８全和加压松质骨螺钉内固定术,使踝穴结构恢复正常。结果 随访８～１８个月,平均１４．５个月病人踝关节功能恢复正常,优良率达８５％。结论 对踝关节骨折伴下胫腓韧还分离的患者在治疗骨折的同时注意修补下胫腓韧带以恢复正常踝穴结构,避兔创伤生骨关节炎发生。     

踝关节骨折合并下胫腓联合韧带损伤的手术疗效分析

目的探讨踝关节骨折合并下胫腓联合韧带损伤内固定手术的效果。方法选取2015-05—2017-02间东莞市人民医院骨伤科收治的104例踝关节骨折合并下胫腓联合韧带损伤患者,根据手术方法不同分组。对照组实施常规非内固定治疗,观察组实施内固定术治疗。比较2组的治疗效果。结果观察组患者的骨折愈合时间短于对照组,术后6个月的踝关节功能评分高于对照组,二次手术发生率低于对照组,差异均有统计学意义(P0.05)。结论对踝关节骨折合并下胫腓联合韧带损伤患者应用内固定术治疗,有助于坚强固定、术后开展功能锻炼及促进骨折愈合。     

合并前胫腓韧带损伤的WeberB型踝关节骨折的手术治疗

目的:评价合并前胫腓韧带损伤的WeberB型踝关节骨折手术治疗效果。方法:对32例合并前胫腓韧带损伤的WeberB型骨折进行手术治疗。结果:32例病人均获得随访(1.2～3.9年),平均2.8年,根据Meyer和Kumler的临床评价标准以及Leeds和Ehrlich的X线片诊断标准进行评价,优良率达94％。结论:合并前胫腓韧带损伤,特别是伴前胫腓韧带撕脱性骨折的WeberB型骨折,手术治疗能获得满意疗效。     

合并前胫腓韧带损伤的WeberB型踝关节骨折的手术治疗

目的:评价合并前胫腓韧带损伤的WeberB型踝关节骨折手术治疗效果.方法:对32例合并前胫腓韧带损伤的WeberB型骨折进行手术治疗.结果:32例病人均获得随访(1.2～3.9年),平均2.8年,根据Meyer和Kumler的临床评价标准以及Leeds和Ehrlich的X线片诊断标准进行评价,优良率达94%.结论:合并前胫腓韧带损伤,特别是伴前胫腓韧带撕脱性骨折的WeberB型骨折,手术治疗能获得满意疗效.     

胫腓钩内固定治疗下胫腓关节分离

踝关节是人体负重最大的关节，踝关节骨折或脱位时出现下胫腓关节分离，将使关节面对位不良，踝穴增宽或变窄，都会引起负重时疼痛或关节不稳定、松动或运动受限，且日后必将发生创伤性关节炎。目前下胫腓关节分离治疗的重要性已被普遍认识，手术治疗多采用螺钉或螺铨内固定。我科自2001年3月～2002年8月采用胫腓钩(Engevlbrecht Syndesmosis Hook)治疗下胫腓关节分离13例，取得满意效果，报告如下。     

不合并踝关节骨折的下胫腓分离

创伤性下胫腓分离通常合并踝关节骨折，不合并踝关节骨折的下胫腓分离非常罕见，下胫腓联合韧带的损伤并不一定导致下胫腓分离。Hopkinson等报告15例下胫腓联合韧带损伤中只有2例出现下胫腓分离，其中1例是在应力X线片中才发现，Rose等也只报告了2例。Edwards等将不合并踝关节骨折的下胫腓分离分为两类：(1)明显的分离(frank     

踝关节损伤并下胫腓韧带联合分离51例临床分析

自1987年～1996年6月,分析了51例踝关节损伤并下胫腓韧带联合分离病人的治疗,随访1～8年,平均3.7年,优良率为76.5％,手术组与非手术组分别为82.1％,58.3％,WeberB型与C型分别为86.4％,45.5％,作者认为WeberC型治疗结果取决于腓骨的解剖复位及螺钉固定方法的选择。     

踝关节骨折脱位中下胫腓联合分离的诊断与治疗

目的探讨治疗伴有下胫腓联合分离的踝关节骨折的手术方法及临床效果。方法回顾性分析2000年1月～2004年6月手术治疗的伴有下胫腓联合分离的踝关节骨折患者18例。患者外踝均采用钢板固定;内踝:11例采用松质骨螺钉固定,6例采用三叶草钢板固定,1例采用克氏针固定;下胫腓联合均采用单枚螺钉经或不经钢板孔固定。结果18例患者获8～25个月随访。所有患者均未发生深部感染、断钉等情况,3例患者在拔钉后下胫腓联合再次出现分离,1例Pilon骨折患者术后早期即发生创伤性关节炎。根据患者主观感觉、功能检查和X线检查评定疗效:本组优9例,良6例,可2例,差1例,优良率为83.3%。结论术前全面评估、正确的手术方法及技术、精确的解剖复位固定是提高踝关节骨折疗效的关键。     

腓骨远端骨折合并下胫腓韧带损伤的手术治疗

目的探讨腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗腓骨远端骨折合并下胫腓韧带损伤的疗效。方法2002年10月～2005年8月,对18例腓骨远端骨折合并下胫腓韧带损伤患者采用腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗。术后小腿石膏托中立位固定,3周后拆除石膏托行功能锻炼并随访疗效。结果所有患者术后获5～36个月(平均10个月)随访,伤口均一期愈合,无一例感染,无局部不良反应。参照改良Baird和Jackson的主、客观和X线评价：优17例,良1例,优良率为100%。结论腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗腓骨远端骨折合并下胫腓韧带损伤,是一种有效的方法,疗效满意。     

关节镜辅助下手术治疗合并下胫腓联合分离的踝关节骨折

目的探讨关节镜辅助下手术治疗合并下胫腓联合分离的踝关节骨折脱位的疗效。方法自2000年3月～2005年3月在关节镜辅助下手术治疗合并下胫腓联合分离的踝关节骨折脱位患者37例，根据AO-Weber分型：B型11例，C型26例。通过关节镜修整软骨缺损的关节面，取出游离体，1／3管型钢板固定外踝，螺钉固定骨折的内踝和后踝。在关节镜监视下准确复位仍有残存不稳的下胫腓联合，并用螺钉固定。结果所有患者获得14～36个月（平均21．4个月）随访，骨折愈合时间11～15周，平均13周。无感染、断钉及下胫腓联合再分离等并发症，根据AOFAS评分：优23例，良10例，可或差4例，优良率为89.1％。结论通过踝关节镜可更准确判断下胫腓联合的稳定性，并更精确地将其复位、固定，操作简便，疗效可靠。     

Malreduction of the tibiofibular syndesmosis in ankle fractures

BACKGROUND: Diagnosis and reduction of syndesmosis injuries in ankle fractures can be challenging. Previous studies have demonstrated that standard radiographic measurements used to evaluate the integrity of the syndesmosis are inaccurate. The purpose of this study was to determine the adequacy of standard postoperative radiographic measurements in assessing syndesmotic reduction compared to CT and to determine the prevalence of postoperative syndesmotic malreduction in a patient cohort. METHODS: Twenty-five patients with ankle fractures and syndesmotic instability who had open reduction and syndesmotic fixation were evaluated. All patients had a standard radiographic series postoperatively followed by a CT scan. Radiographic measurements were made by three observers to determine the tibiofibular relationship. Axial CT scan images were judged for quality of reduction of the syndesmosis by measuring the distance between the fibula and the anterior and posterior facets of the incisura. Differences between the anterior and posterior measurements of more than 2 mm were considered incongruous. RESULTS: Six patients (24%) had evidence of postoperative diastasis using the radiographic criteria, four of whom had evidence of malreduction on postoperative CT scan. Conversely, 13 patients (52%) had incongruity of the fibula within the incisura on CT scan (average 3.6 mm, range 2.0 to 8.0 mm), only four of whom had one or more abnormal radiographic measurements. In 10 (77%) of the 13 malreductions seen on CT scan, the posterior measurement was greater, indicating that internal rotation or anterior translation of the fibula may have occurred. Sensitivity of radiographs was 31% and the specificity was 83% compared to CT. CONCLUSIONS: Many syndesmoses were malreduced on CT scan but went undetected by plain radiographs. Radiographic measurements did not accurately reflect the status of the distal tibiofibular joint in this series of ankle fractures. Furthermore, postreduction radiographic measurements were inaccurate for assessing the quality of the reduction. Although we did not seek to correlate functional outcomes, the known morbidity of postoperative syndesmotic malreduction should lead to heightened vigilance for assessing accurate syndesmosis reduction intraoperatively.     

分类应用螺钉固定下胫腓联合在踝部骨折中的应用

目的:探讨分类应用螺钉固定下胫腓联合分离的手术方式及其在治疗踝关节骨折中的作用。方法:2001-2003年间收治踝部骨折伴下胫腓联合损伤110例,男46例,女64例;年龄18～70岁,平均40岁。按AODanisWeber分型:B型85例,C型25例。采用拉力螺钉固定95例,位置螺钉固定15例。结果:110例均得到随访,随访时间1.5～3年。根据踝关节症状与功能评分的Mazur标准,本组优60例,良38例,可12例,差0例,优良率达90%。无一例断钉。结论:分类应用拉力螺钉或位置螺钉固定下胫腓联合,是一种更科学的手术方法,临床疗效满意。     

三踝骨折合并下胫腓联合分离的手术治疗

目的探讨三踝骨折伴下胫腓联合分离手术治疗的疗效。方法对41例三踝骨折伴下胫腓联合分离的患者采取手术切开复位内固定治疗。结果41例均获随访,时间9—24（16．5±0．4）个月,切口愈合时间7—20d。全部获骨性愈合,平均愈合时间（4±1）个月,无下胫腓螺钉断裂发生。踝关节功能按Leedsetal临床评定标准：优17例,良22例,差2例,优良率95．1％。1例开放性骨折术后6d出现感染,经局部换药、反复冲洗2周后切口愈合。2例合并糖尿病患者分别于术后2、4周发生切口周围无菌性积液,经积极处理未并发伤口感染,关节功能无影响。结论三踝骨折伴下胫腓联合分离采用手术治疗可恢复并稳定踝穴和距骨的解剖关系,踝关节可早期功能锻炼,并可获得满意治疗效果。     

A biomechanical evaluation of the tibiofibular and tibiotalar ligaments of the ankle

The purpose of this ex vivo biomechanical study was to determine the strength and stiffness of the anterior and posterior syndesmotic tibiofibular ligaments and the posterior tibiotalar component of the deltoid ligament. Injuries to these ligaments are a prevalent clinical problem, yet little is known about their mechanical behavior. Ten fresh-frozen cadaver lower extremities (average age at death, 72 +/- 8 years) were harvested. The anterior and posterior tibiofibular ligaments and the posterior tibiotalar component of the deltoid were isolated and prepared as bone-ligament-bone complexes for tensile testing to determine strength, stiffness, and mode of failure. The posterior tibiofibular ligament exhibited greater strength, but not significantly so (p < .05), than the anterior tibiofibular ligament and the posterior tibiotalar component of the deltoid ligament. There were no significant differences in stiffness between the three ligaments tested. The dominant mode of failure for the anterior tibiofibular ligament was ligament substance rupture, primarily near its fibular insertion, whereas the failure modes of the posterior tibiofibular ligament were evenly split between substance ruptures and fibular avulsions. The posterior tibiotalar component of the deltoid ligament ruptured most often near the talar insertion. The tibiofibular ligaments showed greater strength than the lateral collateral and deltoid ligaments, as mentioned in literature. The greater strength of the tibiofibular ligaments relative to the lateral collateral and deltoid ligaments suggests that these ligaments play an important role in ankle constraint.     

踝关节骨折合并距骨软骨损伤的手术治疗

2010年1月～2012年8月,我科共收治踝关节骨折患者36例,术中发现有15例合并距骨软骨损伤,经治疗疗效满意,报道如下。1材料与方法1.1病例资料本组15例,男13例,女2例,年龄25～52岁。踝关节骨折按Lauge-Hansen分类:旋后内收型2例,旋后外旋型6例,旋前外展型3例,旋前外旋型4例。距骨软骨损伤按Berndt-Har-ty分类[1]:Ⅰ型3例,Ⅱ型5例,Ⅲ型3例,Ⅳ型4例。