踝关节骨折合并下胫腓损伤的诊治具有挑战性。漏诊、处理不当并不少见,未得到妥善处理的下胫腓损伤会导致踝关节疼痛、不稳定、功能障碍、关节退变,严重影响患者生活质量。其诊疗充满陷阱,几乎每个骨科新手都踩过坑、吃过亏。 二者关系
解剖 诊断 关节镜下刨刀轻易插入下胫腓间隙,说明下胫腓间隙分离 ≥ 3 mm,意味着下胫腓损伤。注:A 胫骨;B 距骨;C 腓骨。图源:DOI: 10.5435/JAAOS-D-19-00358. 治疗 作者:阿 C 排版:景胜杰 投稿:jingshengjie@dxy.cn 参考文献 [1] Bejarano-Pineda L, Digiovanni CW, Waryasz GR, et al. Diagnosis and Treatment of Syndesmotic Unstable Injuries: Where We Are Now and Where We Are Headed[J]. J Am Acad Orthop Surg, 2021, 29(23): 985-997. DOI:10.5435/jaaos-d-20-01350. [2] Wake J, Martin KD. Syndesmosis Injury From Diagnosis to Repair: Physical Examination, Diagnosis, and Arthroscopic-assisted Reduction[J]. J Am Acad Orthop Surg, 2020, 28(13): 517-527. DOI:10.5435/jaaos-d-19-00358. [3] Kaiser PB, Bejarano-Pineda L, Kwon JY, et al. The Syndesmosis, Part II: Surgical Treatment Strategies[J]. Orthop Clin North Am, 2021, 52(4): 417-432. DOI:10.1016/j.ocl.2021.05.011. [4] Bejarano-Pineda L, Guss D, Waryasz G, et al. The Syndesmosis, Part I: Anatomy, Injury Mechanism, Classification, and Diagnosis[J]. Orthop Clin North Am, 2021, 52(4): 403-415. DOI:10.1016/j.ocl.2021.05.010. [5] Hao KA, Vander Griend RA, Nichols JA, et al. Intraoperative Assessment of Reduction of the Ankle Syndesmosis[J]. Curr Rev Musculoskelet Med, 2022. DOI:10.1007/s12178-022-09769-0. [6] Park YH, Choi WS, Choi GW, et al. Ideal angle of syndesmotic screw fixation: A CT-based cross-sectional image analysis study[J]. Injury, 2017, 48(11): 2602-2605. DOI:10.1016/j.injury.2017.08.067. [7] Coughlin M , Saltzman C , Anderson R, et al . 曼氏足踝外科学 [M]. 第 9 版. 唐康来, 徐林, 译. 北京: 人民卫生出版社,2015:1915. [8] Xie L, Xie H, Wang J, et al. Comparison of suture button fixation and syndesmotic screw fixation in the treatment of distal tibiofibular syndesmosis injury: A systematic review and meta-analysis[J]. Int J Surg, 2018, 60: 120-131. [9] Mckenzie AC, Hesselholt KE, Larsen MS, et al. A Systematic Review and Meta-Analysis on Treatment of Ankle Fractures With Syndesmotic Rupture: Suture-Button Fixation Versus Cortical Screw Fixation[J]. J Foot Ankle Surg, 2019, 58(5): 946-953. [10] Ræder BW, Figved W, Madsen JE, et al. Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial[J]. Bone Joint J, 2020, 102-b(2): 212-219. |
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