Wülker N, Rudert M
Orthopädische Klinik, Medizinische Hochschule Hannover.
Orthopade. 1999 Jun;28(6):476-82. doi: 10.1007/s001320050374.
In lateral ankle ligament tears, the anterior talofibular ligament ruptures most commonly, often in conjunction with the calcaneofibular ligament. The posterior talofibular ligament is rarely affected. Associated injuries at the adjacent ligamentous structures or at the articular cartilage of the ankle commonly occur. The diagnosis is established clinically with the anterolateral drawer sign and an increased lateral talar tilt. Stress radiographs in two planes demonstrate talar tilt and anterior displacement of the talus, in comparison to the unaffected side. Magnetic resonance imaging provides an early diagnosis of concomitant injuries. Simple, acute lateral ankle ligament tears are treated non-operatively. Surgery is indicated in dislocated bone avulsions and in chondral or osteochondral fractures. A recurrent tear in an athletic patient should also be treated operatively. Athletic endeavours, the number of torn ligaments and patient age are no useful indicators for surgical treatment. Conservative treatment consist of oedema therapy, immobilization of the fibular ligaments with as little compromise of ankle joint function as possible, and rehabilitation with muscle strengthening and proprioception training. During surgery, the ligament stumps are reapproximated in anatomic position, reinforced with local tissue if necessary, and the articular surface is examined for concomitant injuries.
在外侧踝关节韧带撕裂中，距腓前韧带最常断裂，通常还伴有跟腓韧带断裂。距腓后韧带很少受累。踝关节相邻韧带结构或关节软骨处常伴有损伤。临床通过前外侧抽屉试验和距骨外侧倾斜增加来确诊。与未受影响侧相比，在两个平面上的应力X线片可显示距骨倾斜和距骨向前移位。磁共振成像可早期诊断合并损伤。单纯的急性外侧踝关节韧带撕裂采用非手术治疗。脱位的骨撕脱伤以及软骨或骨软骨骨折则需手术治疗。运动患者反复出现的撕裂伤也应进行手术治疗。运动项目、撕裂韧带的数量和患者年龄对手术治疗并无指导意义。保守治疗包括消肿治疗、尽可能减少踝关节功能受损的情况下固定腓骨韧带，以及通过肌肉强化和本体感觉训练进行康复治疗。手术过程中，将韧带残端在解剖位置重新对合，必要时用局部组织加强，并检查关节面是否有合并损伤。
