手术治疗踝关节骨折合并下胫腓联合分离的效果

 目的 探讨手术治疗踝关节骨折合并下胫腓联合分离的效果。方法 回顾性分析2013-04至2016-10收治的42例踝关节骨折者合并下胫腓联合分离患者,均采用切开复位钢板、螺钉内固定,下胫腓联合采用1枚螺钉固定,术后8周取出固定下胫腓的螺钉。随访24个月,观察预后效果。结果 42例术后均获随访,随访时间10~24个月,平均18个月,骨折均愈合,无下胫腓联合再分离。AOFAS评分:优33例,良6例,可2例,差1例,优良率92.8%。结论 对于踝关节骨折合并下胫腓联合韧带损伤,除骨折有效固定外,术中恢复下胫腓联合的解剖复位及固定有利于提高骨折治疗的优良率,降低二次手术的发生率,值得临床推广应用。     

锚钉修复三角韧带结合内固定治疗旋前外旋Ⅳ度踝关节骨折

目的探讨应用锚钉修复三角韧带损伤结合钢板螺钉内固定治疗旋前外旋Ⅳ度踝关节骨折的疗效。方法 2009年8月~2011年10月,对26例旋前外旋型Ⅳ度踝关节骨折行切开复位内固定,并植入锚钉修复三角韧带深层和浅层,恢复内、外侧结构的稳定性。术后观察骨折愈合及患者踝关节功能恢复情况。结果 26例随访6~30个月,平均16个月。所有骨折均愈合,时间10~16周,平均12周。1例未固定下胫腓联合的患者,负重后逐渐出现踝穴增宽、距骨外移导致创伤性关节炎而疼痛。采用Mazur踝关节症状与功能评分评定疗效:优15例,良8例,可2例,差1例,优良率为88.5%。无感染、骨折不愈合、锚钉松动等发生。结论应重建旋前外旋型踝关节骨折中三角韧带的连续性及下胫腓联合的稳定性,锚钉具有创伤小、对踝关节生理影响小等特点,是修复三角韧带损伤的有效方法。     

下胫腓螺钉固定联合下胫腓韧带修复治疗踝关节骨折合并下胫腓联合损伤的疗效

目的:探讨下胫腓螺钉固定联合下胫腓韧带修复治疗踝关节骨折合并下胫腓联合损伤的疗效。方法:采用回顾性队列研究分析2017年9月至2020年9月联勤保障部队第九〇九医院收治的72例踝关节骨折合并下胫腓联合损伤患者临床资料,其中男38例,女34例;年龄19~65岁［（42.5±12.2）岁］。按Danis-Weber分型,B...     

生物聚酯人工韧带加可吸收内固定与金属内固定治疗三踝骨折的疗效比较

笔者对 2 6例合并下胫腓韧带损伤的三踝骨折患者 ,分别采用生物聚酯人工韧带 可吸收内固定重建下胫腓韧带和金属内固定两种方法进行治疗。现就其不同疗效报告如下。内固定材料介绍1.生物聚酯人工韧带 :法国ＡＴＩＣＡＬ公司生产 ,品名Ｂｉｏｐｌｙｐｏｌｙｅｓｔｅｒｌｉｇａｍｅｎｔ,编织成不同的形状供不同的用途。本研究中选用的多功能加固韧带 ,其抗拉强度 >6 5 0Ｎ ,在体内 1年左右完全降解 ,具有良好的生物相容性 ,植入体内无任何毒性[1 ] 。2 .可吸收螺钉 :芬兰ＢＩＯＮＸ内植物公司产品 ,品名Ｂｉｏｆｉｘ ,直径 2 .0ｍｍ或3 .2ｍ…     

韧带重建治疗陈旧性下胫腓联合韧带损伤

踝关节骨折是临床常见的一种创伤,其发生率约占全身骨折的3.9%[1],占关节内骨折的第一位[2]。对踝关节骨折的治疗,临床上常重视骨折的复位和固定,而忽视了对三角韧带、下胫腓联合韧带等软组织稳定结构的修复,导致术后效果不满意。下胫腓联合韧带由下胫腓前韧带、下胫腓后韧带、骨间韧带、下胫腓横韧带和骨间膜的远端部分组成,是维持踝关节稳定性的重要结构。下胫腓韧带损伤后如不进行治疗,可导致踝关节不稳定,引起患者踝     

胫腓钩板治疗踝关节骨折并下且奎腓联合分离21例

踝关节损伤手法复位通常因为软组织嵌入较难达到解剖复位,近年来多采用手术治疗。下胫腓联合分离的手术治疗以往多采用螺钉、可吸收钉、骨栓等绝对固定,这不符合下胫腓联合弹性内固定的治疗要求。我科自2004－06至2008－04采用胫腓钩板治疗外踝骨折井下胫腓联合分离21例,取得良好效果。     

两种材料螺钉固定下胫腓联合损伤的前瞻性随机对照研究

目的 通过前瞻性随机对照研究评估金属(钛合金)和生物可吸收(多聚左旋乳酸)螺钉固定下胫腓联合的疗效,并分析潜在的并发症风险.方法 2007年1月- 2008年5月共48例踝关节骨折伴下胫腓联合损伤患者入组.通过随机数字表法实现完全随机分组,其中金属螺钉固定组20例,可吸收螺钉固定组28例.47例患者接受至少2年的随访,进行影像学和临床评估.结果 总随访率达98％.两组患者人口学信息差异无统计学意义(P＞0.05).随访满1年及2年时,两组间Baird评分各指标、总分及Baird评级差异均无统计学意义(P＞0.05).至随访末,两组患、健侧踝关节之间活动度差异有统计学意义(P＜0.05).可吸收螺钉组主要出现2例中度排异反应及2例下胫腓异位骨化并发症.结论 可吸收螺钉是下胫腓联合损伤固定的有效内置物,与金属材料螺钉相比,可避免二次手术取出,同时可以达到与前者相同的固定效果.但其也存在多种并发症的可能,如排异反应及异位骨化等不容忽视.     

胫腓下联合韧带损伤的诊治

踝关节损伤中 ,术前踝穴摄片结合术中胫腓下联合探查是确定固定胫腓下联合的有效方法     

下胫腓韧带损伤

<正> Maisonneure早在1840年描述了距骨在踝关节内旋转可引起踝部骨折,同时可合併下胫腓韧带损伤的机制以来,在相当长的时期内,这一见解未被人们注意。四十年代以后不少学者在踝关节损伤的诊治中提到下胫腓韧带     

下胫腓联合分离螺钉固定术后断钉6例分析

下胫腓联合分离因非手术治疗不能有效固定胫腓联合,故目前大多倾向手术治疗[1].2003年1月-2008年1月我科治疗涉及下胫腓联合分离踝关节损伤78例,其中有6例出现下胫腓联合横向螺钉断裂,占7.7%.     

Treatment of chronic syndesmotic injury: a systematic review and meta-analysis

Purpose

The purpose of this study is to systematically review and meta-analyse the available literature on the treatment of chronic syndesmotic injuries of the ankle.

Methods

A systematic review of the PubMed/MEDLINE and EMBASE databases was conducted in August 2012 utilizing the keywords (treatment OR intervention) AND (injury OR sprain OR rupture) AND (syndesmosis OR syndesmotic OR “high ankle” OR “anterior inferior tibiofibular ligament” OR AITFL OR “posterior inferior tibiofibular ligament” OR PITFL OR tibiofibular diastasis). Studies that reported the outcomes of the surgical treatment of chronic syndesmotic injury were included in our review. Chronic was defined as symptoms longer than 6 months. Meta-analysis based on random-effects models was performed to pool the rates of success for different treatment methods.

Results

The search yielded 416 publications from PubMed/MEDLINE and 473 publications from EMBASE. After abstract and full-text review, 15 articles were included in this review. Treatment methods were placed into three broad surgical treatment categories: screw fixation, arthrodesis and arthroscopic debridement. The most common treatment strategy employed was screw fixation. The pooled rates of success for screw fixation, arthrodesis and arthroscopic debridement were 87.9, 79.4 and 78.7 %, respectively.

Conclusion

The current evidence on the treatment of chronic syndesmosis injuries in the ankle is limited to prospective and retrospective case series. The pooled success rates for screw fixation, arthrodesis and arthroscopic debridement each exceeded 78 %. Future high-level studies are required to discern the most appropriate treatment strategy(ies) for chronic syndesmotic injuries of the ankle.     

三种螺钉固定方式治疗下胫腓联合分离对踝关节功能影响的比较研究

目的评估应用螺钉穿透三层或四层皮质治疗下胫腓联合分离对踝关节术后功能的影响。方法将重庆市涪陵区人民医院骨科2012年6月—2015年9月收治的32例踝关节骨折合并下胫腓联合分离损伤的患者作为研究对象,所有患者随机分为三组,第1组采用1枚螺钉穿透三层皮质固定下胫腓联合(12例),第2组采用1枚螺钉穿透四层皮质固定下胫腓联合(12例),第3组采用2枚螺钉穿透三层皮质固定下胫腓联合(8例)。记录患者骨折类型、住院时间、住院费用及术后踝关节功能评分。结果所有患者均顺利完成手术,并得到术后随访,最终随访时间为术后1年。三组患者术后踝关节Olerud-Molander评分、踝关节活动度以及平均住院时间(12.03±2.0)d,差异无统计学意义(P0.05);在住院费用上,第1组(1.07±0.2)万元和第2组(1.09±0.3)万元,明显少于第3组(1.4±0.2)万元,差异有统计学意义(P0.05)。结论不同固定方式对术后踝关节功能无显著影响,单颗螺钉固定效果良好,且患者总体费用少,适用于基层单位。     

双带绊纽扣钢板治疗下胫腓联合损伤的临床研究

目的 探讨双带绊纽扣钢板治疗下胫腓联合损伤的疗效.方法 自2008年2月~2010年1月,采用双带绊纽扣钢板治疗伴下胫腓联合损伤的踝关节骨折脱位14例.通过随访及标准的足踝功能评分,评估该治疗方法的疗效.结果 14例均获随访,随访时间13~35(16.1±2.3)个月.术后X线片均见踝穴正常.根据改良Baird-Jac...     

Deltoid Ligament and Tibiofibular Syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy

Objective

To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI).

Materials and Methods

Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard.

Results

On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively.

Conclusion

Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.     

MRI findings associated with distal tibiofibular syndesmosis injury

OBJECTIVE: Our objective was to describe the MRI findings associated with acute and chronic distal tibiofibular syndesmosis injury. MATERIALS AND METHODS: Ninety-four 1.5-T MRIs of ankles of 90 individuals with histories of severe sprain were assessed by two musculoskeletal radiologists for syndesmosis injury (acute, edema of the syndesmosis; chronic, disruption or thickening of the syndesmosis without edema). We examined associated MRI findings, including anterior talofibular ligament injury (scar, chronic injury; edema, acute injury), bone bruise, osteochondral lesion, tibiofibular joint congruity, tibiofibular recess height, and osteoarthritis. The Fisher's exact test and analysis of variance test were used to evaluate the significance of the associations. RESULTS: In 94 ankles, syndesmosis injury was seen in 63% (n = 59; 23 acute; 36 chronic). Anterior talofibular ligament injury (acute or chronic) was seen on MRIs in 74% (n = 70; 49 with syndesmosis injury; 21 without; p = 0.03). Bone bruises were present in 24% (n = 23; 18/23 acute; 4/36 chronic; 4/35 no injury; p < 0.0001). Of these, talar dome osteochondral lesions were present in 28% (n = 26; 11/23 acute; 14/36 chronic; 1/35 no injury; p = 0.0001; 13 medial; 13 lateral). The tibiofibular joint was incongruent in 33% (n = 31; 6/23 acute; 21/36 chronic; 4/35 no injury; p < 0.0001). The tibiofibular recess (mean +/- SD) was 1.2 +/- 0.92 cm in acute cases, 1.4 +/- 0.57 cm in chronic cases, and 0.54 +/- 0.68 cm in cases with no syndesmosis injury (p < 0.0001). Osteoarthritis was present in 10% (n = 9; 1/23 acute; 7/36 chronic; 1/35 no injury; p = 0.06). CONCLUSION: Injury to the distal tibiofibular syndesmosis has a significant association with a number of secondary findings on MRI, including anterior talofibular ligament injury, bone bruises, osteochondral lesions, tibiofibular joint congruity, and height of the tibiofibular recess.     

103例踝关节骨折脱位的治疗

目的：总结踝关节骨折脱位治疗的经验,方法对１９８７－１９９７年１０３例踝关节骨折脱位治疗情况进行分析,随访６个月－５年,平均２年３个月,采用Ｗｅｂｅｒ评分标准评定临床疗效。结果手法治疗３８例：优１３例（３４％）,良１８例（４７％）,差７例（１９％）,优良率为８２％,其中单纯外踝骨折１４例,仅１４％（２／１４）获得解剖复位,但临床疗效优良率达（１３／１４）,手术治疗６５例;优３４例（５２％）良２３例     

Lateral ankle fracture with missed proximal tibiofibular joint instability (Maisonneuve injury)

We present a case of a soccer player who sustained a lateral ankle fracture and the associated proximal anterolateral tibiofibular joint instability (Maisonneuve injury) was overlooked. After a non-contact injury the (incomplete) diagnosis of a lateral malleolar fracture (type Weber B, AO 44-B1) was made and the patient was surgically treated with open reduction and internal fixation including a distal syndesmosis screw. After removal of the syndesmosis screw (six weeks after surgery) the patient suffered from activity-related pain around the fibular head. After thorough clinical and radiologic examination, temporary screw transfixation of the fibular head and capsular repair under meticulous fluoroscopic control of fibular rotation helped to restore patient’s sport activity level. This case report emphasizes the importance of precise clinical examination for detection of a proximal tibiofibular joint instability. Restoration of a well functioning and stable proximal tibiofibular joint may be difficult to achieve in previously operated and missed instabilities. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

旋前外旋型踝关节骨折损伤特点及疗效分析

目的探讨旋前外旋型踝关节骨折的损伤特点及手术治疗疗效。方法回顾性分析2011年1月—2014年2月手术治疗的21例旋前外旋型踝关节骨折患者,男性11例,女性10例;平均年龄33.9岁(16~57岁)。阅读X线片及CT等影像学资料,判断是否合并后踝骨折、下胫腓联合分离、胫距关节脱位及胫距关节面是否粉碎,采取Baird-Jackson踝关节功能评定标准判定手术疗效。结果 21例中旋前外旋型Ⅳ度19例,Ⅲ度2例,其中18例存在下胫腓联合分离,15例使用螺钉稳定下胫腓联合。合并后侧及外侧脱位者14例,外侧脱位者1例,后侧半脱位者1例,无脱位者5例,脱位率76.2%。7例后踝骨折胫骨远端关节面塌陷,可见游离骨碎片。末次随访(术后11~13个月,平均12.4个月)时,Baird-Jackson评分为81~100分,平均94.1分;其中优10例,良6例,中5例,优良率76.2%。结论旋前外旋型Ⅲ~Ⅳ度踝关节骨折多合并胫距关节脱位及下胫腓联合分离,需要复位固定下胫腓联合,正确的解剖复位及内固定,可获得满意的临床疗效。