踝关节骨折伴下胫腓联合分离的手术治疗及临床意义

目的探讨治疗踝关节骨折伴下胫腓联合分离的手术方法及临床意义。方法自2002年1月～2005年12月对112例伴踝关节骨折下胫腓联合分离行腓骨内固定或不固定,内踝内固定,三角韧带探查修复术。未固定下胫腓联合。术后随访6～36个月,平均20.8个月。结果用Mazur评分系统评估手术疗效:优98例,良14例。未见骨折不愈合、关节不稳及创伤性关节炎等并发症。结论对伴下胫腓联合分离的踝关节骨折行手术治疗时,除了固定内、外踝,还要修复三角韧带损伤。恢复了内、外侧所有结构的完整性后才能真正恢复下胫腓联合及踝关节的正常生物力学环境和稳定性,这时即使不固定下胫腓联合,也可以获得下胫腓联合的稳定。固定内、外踝和下胫腓联合,而三角韧带的损伤不修复,虽然下胫腓韧带可以获得愈合,但三角韧带会愈合不佳、韧带松弛及功能不良,最终仍会导致创伤性关节炎。

Operative Treatment and Clinical Significance of Ankle Fracture with Syndesmotic Separation

Objective To analyze the operative treatment and clinical significance of the ankle fracture with syndesmotic separation.Methods From January 2002 to December 2005,112 ankle fractures with syndesmotic separation were treated.Fracture of fibula and medial malleolus was treated by open reduction and internal fixation with AO small fragment plate and screw respectively.The proximal fibula fracture might not be fixed.The deltoid ligament was routinely explored and repaired.The syndesmosis was not fixed.The mean follow-up period was 20.8 months with a range from 6 to 36 months.Results According to the criteria of ankle function evaluation set up by the Mazur scores,the excellent results were found in 98 cases,good in 14.No patient had nonunion,ankle instability,and traumatic arthritis.Conclusion The operative treatment of the ankle fracture with syndesmotic separation consists of the open reduction and internal fixation of fibula and medial malleolus.Besides,exploring and repairing the deltoid ligament routinely is necessary.The normal biomechanical environment and stability of the ankle can really be achieved so long as the integrity of the medial and lateral structure of the ankle is restored.The syndesmotic stability can also be obtained by this way in spite of not fixing the syndesmosis.On the contrary,fixing the fibula,medial malleolus and syndesmosis and not repairing the deltoid ligament will ultimately lead to the traumatic arthritis,and it is not important to obtain syndesmotic healing.