Zalavras Charalampos, Thordarson David
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90089-9312, USA.
J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. doi: 10.5435/00124635-200706000-00002.
Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. Syndesmotic injury may occur in isolation or may be associated with ankle fracture. In the absence of fracture, physical examination findings suggestive of injury include ankle tenderness over the anterior aspect of the syndesmosis and a positive squeeze or external rotation test. Radiographic findings usually include increased tibiofibular clear space decreased tibiofibular overlap, and increased medial clear space. However, syndesmotic injury may not be apparent radiographically; thus, routine stress testing is necessary for detecting syndesmotic instability. The goals of management are to restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis. Fixation of the syndesmosis is indicated when evidence of a diastasis is present. This may be detected preoperatively, in the absence of fracture, or intraoperatively, after rigid fixation of the medial malleolus and fibula fractures. Failure to diagnose and stabilize syndesmotic disruption adversely affects outcome.
下胫腓联合损伤不一定会导致踝关节不稳定；然而，三角韧带损伤的并存会严重破坏踝关节的稳定性。下胫腓联合损伤可能单独发生，也可能与踝关节骨折相关。在没有骨折的情况下，提示损伤的体格检查结果包括下胫腓联合前方的踝关节压痛以及挤压试验或外旋试验阳性。影像学表现通常包括胫腓间隙增宽、胫腓重叠减少以及内侧间隙增宽。然而，下胫腓联合损伤在影像学上可能不明显；因此，常规应力试验对于检测下胫腓联合不稳定是必要的。治疗的目标是恢复并维持正常的胫腓关系，以利于下胫腓联合韧带结构的愈合。当存在分离的证据时，需对下胫腓联合进行固定。这在术前无骨折时或在内侧踝和腓骨骨折进行坚强固定后术中可能被检测到。未能诊断和稳定下胫腓联合分离会对治疗结果产生不利影响。
