Bai Xiao-dong, Xing Geng-yan, Yang Chuan-duo, Ye Qi-bin
Department of Orthopaedics, General Hospital of Chinese People Armed Police Forces, Beijing 100039, China.
Chin J Traumatol. 2006 Jun;9(3):175-80.
To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis.
From July 1997 to July 2002, we treated 87 patients (64 males and 23 females, aged 18-54 years) with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus longus, reduction of the separated distal tibiofibular syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30 degrees when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation.
These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint: excellent in 55 patients (63%), good in 18 patients (21%), and fair in 14 patients (16%). Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus longus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise.
Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus longus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.
研究下胫腓联合分离对踝关节的影响，并比较各种手术方法，以寻找适合下胫腓联合分离的稳定方法。
1997年7月至2002年7月，我们治疗了87例下胫腓联合分离患者（男64例，女23例，年龄18 - 54岁），其中79例合并有踝关节骨折。对37例患者行手法复位、松质骨螺钉内固定及石膏外固定；对34例患者行腓骨骨折钢板螺钉固定及下胫腓联合松质骨螺钉固定；对16例患者行用腓骨长肌腱修复下胫腓韧带、下胫腓联合分离复位及松质骨螺钉固定。用松质骨螺钉固定下胫腓联合时，踝关节背伸30度。术后8 - 10周取出松质骨螺钉。
这些患者至少随访两年。根据患者主诉及踝关节外形、功能和X线片评估疗效：优55例（63%），良18例（21%），可14例（16%）。2例下胫腓联合分离复发，再次手术用腓骨长肌腱修复下胫腓韧带后恢复。1枚松质骨螺钉折断。踝关节前侧皮肤无坏死发生。
下胫腓联合分离可采用多种合理手术治疗。用腓骨长肌腱修复对下胫腓联合完全分离可取得良好疗效。
