Rammelt Stefan, Zwipp Hans, Grass René
Klinik und Poliklinik für Unfall und Wiederherstellungschirurgie, Universitätsklinikum, "Carl Gustav Carus" der TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Foot Ankle Clin. 2008 Dec;13(4):611-33, vii-viii. doi: 10.1016/j.fcl.2008.08.001.
Injuries to the distal tibiofibular syndesmosis are frequent in collision sports. Most of these injuries are not associated with latent or frank diastasis between the distal tibia and fibula and are treated as high ankle sprains, with an extended protocol of physical therapy. Relevant instability of the syndesmosis results from rupture of two or more ligaments leading to a diastasis of more than 2 mm and requiring surgical fixation. Most of these syndesmosis ruptures are associated with bony avulsions or malleolar fractures. Treatment consists of anatomic reduction of the fibula and fixation with one or two tibiofibular syndesmosis screws. Proper reduction and positioning of the screws are more predictive of a good clinical result than the material, size, and number of cortices purchased. Chronic injuries without instability are treated by arthroscopic or open debridement and arthrolysis. Chronic syndesmotic instability can be treated with a three-strand peroneus longus ligamentoplasty in the absence of symptomatic arthritis or bony defects.
胫腓下联合损伤在对抗性运动中很常见。这些损伤大多与胫腓骨远端之间潜在或明显的分离无关，而是被当作高位踝关节扭伤来治疗，并采用延长的物理治疗方案。联合的相关不稳定是由两条或更多韧带断裂导致分离超过2毫米且需要手术固定引起的。这些联合损伤大多与骨撕脱或踝关节骨折有关。治疗包括腓骨的解剖复位并用一枚或两枚胫腓联合螺钉固定。螺钉的正确复位和定位比所购买螺钉的材料、尺寸和皮质骨数量更能预示良好的临床效果。无不稳定的慢性损伤通过关节镜或切开清创及关节松解术治疗。在没有症状性关节炎或骨缺损的情况下，慢性联合不稳定可用三股长腓骨韧带成形术治疗。
