下胫腓联合螺钉治疗下胫腓韧带联合损伤的临床观察

目的：探讨踝关节周围骨折合并下胫腓韧带联合损伤的手术方法。方法：对2005年9月至2007年12月用下胫腓联合螺钉固定治疗的20例（21踝）下胫腓韧带联合损伤患者进行回顾性研究,其中男11例（12踝）,女9例（9踝）;年龄27～52岁,平均36岁。所有患者结合病史、查体及影像学检查进行诊断,按照Lauge-Hansen分型进行手术治疗。X线测量：①胫骨前结节与腓骨的重叠阴影;②下胫腓联合间隙;③内踝关节面与距骨关节面的间隙。临床疗效采用改良Baird-Jackson评分标准进行评价。结果：20例（21踝）均获得随访,时间1～2.2年,平均1.3年。术前正侧位下胫腓联合重叠影为（0.46±3.56）mm,下胫腓联合间隙为（5.69±0.88）mm,胫距关节内间隙为（5.67±1.23）mm,踝穴位下胫腓联合重叠影为（-0.87±0.96）mm;术后下胫腓联合重叠影为（7.14±0.62）mm,下胫腓联合间隙为（3.28±0.39）mm,胫距关节内间隙为（3.12±0.33）mm,踝穴位下胫腓联合重叠影为（2.91±0.30）mm,与术前比较差异均有统计学意义（P〈0.01）。术后CT复查显示：下胫腓联合仍存在一定程度分离的有4例,均为轻度。术后Baird-Jackson评分为（86.24±13.26）分（62～98分）,在各项评定内容中,13踝（61.90%）获得无痛踝关节,16踝（76.19%）无踝关节不稳征象,11踝（52.38%）恢复正常行走能力,8踝（38.10%）恢复正常奔跑能力,11踝（52.38%）恢复正常的工作能力。踝关节背伸活动度（21.05±5.00）°,跖屈活动度（33.57±5.76）°,内翻活动度（19.48±4.57）°,外翻活动度（24.05±4.86）°。踝关节发生创伤性骨性关节炎表现的患者3例,无一例发生断钉;临床疗效优12踝,良2踝,可4踝,差3踝。结论：下胫腓联合3层皮质螺钉固定是治疗下胫腓韧带联合损伤的有效方法之一,精细的手术操作技术和下胫腓联合解剖关系的恢复是患者获得良好踝关节功能的重要因素,术后常规?

Treatment of syndesmosis diastasis with screw fixation in ankle fractures

Objective：To explore the operative method for the treatment of syndesmosis injury in ankle fractures. Methods： A retrospective study was done on 21 ankles of 20 patients included male 11 and female 9;the range of age were from 27 to 52 years with an average of 36 years） with syndesmosis injury in closed ankle fractures from September 2005 to December 2007. All patients with ankle fractures and syndesmosis injury were diagnosed by the history,physical examination and radiology,then treated with open reduction,internal fixation,and syndesmotic stabilization with a three cortices syndesmotic screw according to the Lauge-Hansen classification system. Radiological evaluation comprised tibiofibular overlap,total clear space and medial clear space. The clinical effects were evaluated according to modified Baird-Jackson standard. Results：All patients were followed up from 1.0 to 2.2 years with an average of 1.3 years. Radiographic measurements were detailed as follows： tibiofibular overlap averaged （0.46±3.56） mm in preoperative and （7.14±0.62） mm in postoperative;mean total clear space （5.69±0.88） mm in preoperative and （3.28±0.39） mm in postoperative;medial clear space averaged （5.67±1.23） mm in preoperative and （3.12±0.33） mm in postoperative;tibiofibular overlap in mortise view averaged（-0.87±0.96）mm in preoperative and（2.91±0.30） mm in postoperative. There was significant difference above data between preoperative and postoperative （P 0.01）. Four cases were confirmed minor tibiofibular diastasis through CT scans during postoperative. The modified Baird-Jackson scoring was from 62 to 98 scores with an average of （86.24±13.26） score at the final review. Of them,13 ankles had not pain;16 ankles reported no instability complaints;11 ankles gained normal walking ability;8 ankles could run normally;11 ankles could return work without any restrictions. Activity of ankle in dorsiflexion,plantar flexion,inversion and eversion were respectively（21.05±5.00）°,（3