Valkering Kars P, Vergroesen Diederik A, Nolte Peter A
Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Orthopedics. 2012 Dec;35(12):e1705-10. doi: 10.3928/01477447-20121120-13.
Isolated syndesmosis injuries often go unrecognized and are diagnosed as lateral ankle sprains; however, they are more disabling than lateral ankle sprains. The reported incidence of isolated syndesmosis injuries in acute ankle sprains ranges between 1% and 16%. When ankle disability lasts for more than 2 months after an ankle sprain, the incidence increases to 23.6%. Diagnostic workup may include stress radiographs, magnetic resonance imaging, or diagnostic arthroscopy. A simple stress test radiograph may reveal an unstable grade III syndesmosis sprain that may go unrecognized on plain anteroposterior and mortise or lateral radiographs of the ankle. The duration of symptoms in isolated syndesmosis injury is longer and more severe, often leading to chronic symptoms or ankle instability requiring operative stabilization.This article describes the clinical presentation, injury classification, and operative stabilization techniques of isolated syndesmosis injuries. The authors performed their preferred operative stabilization technique for isolated syndesmosis injury-arthroscopic debridement of the ankle with syndesmotic stabilization with a syndesmotic screw-in 4 patients. All patients were evaluated 1 year postoperatively with subjective and objective assessment scales. Three of 4 patients showed good improvement of general subjective ankle symptoms and subjective ankle instability rating and a high Sports Ankle Rating System score after 1 year.
单纯下胫腓联合损伤常未被识别，而被诊断为外侧踝关节扭伤；然而，它们比外侧踝关节扭伤更具致残性。据报道，急性踝关节扭伤中单纯下胫腓联合损伤的发生率在1%至16%之间。当踝关节扭伤后踝关节功能障碍持续超过2个月时，发生率增至23.6%。诊断检查可能包括应力位X线片、磁共振成像或诊断性关节镜检查。一张简单的应力试验X线片可能显示出不稳定的III度下胫腓联合扭伤，而在踝关节的前后位、斜位或侧位平片上可能无法识别。单纯下胫腓联合损伤的症状持续时间更长且更严重，常导致慢性症状或踝关节不稳定，需要手术稳定。本文描述了单纯下胫腓联合损伤的临床表现、损伤分类及手术稳定技术。作者对4例患者采用了他们首选的单纯下胫腓联合损伤手术稳定技术——踝关节镜下清创并使用下胫腓螺钉进行下胫腓联合稳定。所有患者术后1年采用主观和客观评估量表进行评估。4例患者中有3例在1年后总体主观踝关节症状、主观踝关节不稳定评分有明显改善，且踝关节运动评分系统得分较高。
