自体肌腱移植修复上胫腓关节脱位

背景：上胫腓关节脱位并不常见，临床上经常合并其他损伤，所以容易被忽视漏诊，进而导致膝关节慢性疼痛、感觉迟钝、活动受限等不良后果。 目的：尝试用自体肌腱移植进入骨性隧道来重建正常的上胫腓关节。 方法：2009年以来西山煤电集团职工总医院共收治3例外院漏诊及处理不当的上胫腓关节脱位患者，其中1例为26岁男性军人，1例为36岁男性矿工，另外1例为36岁女性运动员，此3例患者尽管临床症状表现不同，但腓骨小头处都有压痛及漂浮感，辅助检查（X射线/MRI）都表现为阴性。3例患者均采取用同侧自体半键肌、股薄肌肌腱修复上胫腓关节脱位，以达到重建上胫腓关节的目的。 结果与结论：3例上胫腓关节脱位患者术后功能锻炼的效果均令人满意，患者膝关节外侧肿胀、腓骨头处的明显压痛及漂浮感和踝关节活动时疼痛及感觉受限的症状全部消失，踝部及足部的感觉及肌肉力量恢复至正常。提示可以应用自体肌腱移植重建上胫腓关节脱位，为避免漏诊，医生在术前应查看腓骨小头是否活动。

Autologous tendon graft for the repair of superior tibiofibular joint dislocation

BACKGROUND：Superior tibiofibular joint dislocation is not common, and often combined with other injuries in the clinic, so it is easy to be neglected or missed. Thus, some side outcomes appeared, such as chronic knee joint pain, dysesthesia and limitation of motion. OBJECTIVE：To reconstruct normal superior tibiofibular joint by using autologous tendon graft to bone tunnel. METHODS：Three patients with superior tibiofibular joint dislocation, who were missed and treated with improper method, were enrol ed in Workers General Hospital, Xishan Coal Electricity Group since 2009. One was a male soldier aged 26 years old;one was a male miner aged 36 years old;one was a female athlete aged 36 years old. The clinical symptoms were different in these three patients, but their capitulum fibulae had the feeling of tenderness and flotation. Accessory examinations （X-ray/MRI） presented negative. Ipsilateral autologous semitendinosus muscles and gracilis tendon were used to repair superior tibiofibular joint dislocation in the three patients so as to reconstruct superior tibiofibular joint. RESULTS AND CONCLUSION：The effects of postoperative functional exercise were satisfactory in three patients with superior tibiofibular joint dislocation. Lateral knee joint was swol en. Fibular head presented obvious tenderness and floating feeling. When ankle joint was moving, pain and limitation of motion completely disappeared. The sense of ankle and foot and the strength of muscle recovered to normal. These results indicated that to avoid missed diagnosis, physicians should check whether the capitulum fibulae was moving or not before autologous tendon graft was utilized to reconstruct superior tibiofibular joint dislocation.