Lin Cheng-Feng, Gross Michael L, Weinhold Paul
Center for Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7135, USA.
J Orthop Sports Phys Ther. 2006 Jun;36(6):372-84. doi: 10.2519/jospt.2006.2195.
Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.
下胫腓联合损伤较为罕见，但极具致残性且常被误诊。本临床评论的目的是回顾下胫腓联合损伤的机制、临床检查方法、诊断及治疗。还回顾了下胫腓联合和三角韧带的尸体研究，以进一步了解应力传递以及不同结构在稳定下胫腓联合远端中的作用。据报道，足在小腿上的外旋和过度背屈是最常见的损伤机制。这种损伤最常发生在参与滑雪、美式橄榄球、足球以及其他在草坪上进行的体育活动的人群中。外旋试验和挤压试验是检测这种损伤的可靠方法。影像学检查辅助准确诊断的能力可能取决于损伤的严重程度。尸体研究结果表明三角韧带在维持胫腓下联合远端稳定性和踝关节榫眼的一致性方面的重要性。建议采用早期严格固定和疼痛缓解策略的干预方案，随后进行强化和平衡训练。足跟抬高和后侧夹板干预可用于避免踝关节过度背屈引起的下胫腓联合分离。应用刚性外部装置时应谨慎，以防止踝关节上方小腿的内外侧受压，从而导致下胫腓联合关节分离。当存在下胫腓联合韧带完全撕裂或观察到骨折时，手术干预是一种选择。
