Johnson Zackary A, Ryan Paul M, Anderson Claude D
Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
Arthrosc Tech. 2016 Mar 21;5(2):e263-8. doi: 10.1016/j.eats.2015.12.006. eCollection 2016 Apr.
Subtle syndesmotic instability not evident on radiography can result in chronic ankle pain. The diagnosis is uncommon, and arthroscopic evaluation remains the gold standard for diagnosis. Definitive surgical management can be performed at the time of diagnosis. Patients with 2 to 4 mm of diastasis of the syndesmosis or translation can be treated with debridement alone, and patients with 4 mm or more of diastasis or translation can be treated with arthroscopic debridement and reduction followed by percutaneous stabilization. Percutaneous stabilization is accomplished by a TightRope technique, which involves passing 1 or 2 suture buttons through all 4 cortices of the distal tibia and fibula. This technique is used in lieu of the traditional syndesmotic screw, which requires a subsequent operation for removal.
X线片上不明显的细微下胫腓联合不稳定可导致慢性踝关节疼痛。这种诊断并不常见，关节镜评估仍是诊断的金标准。确诊时可进行确定性手术治疗。下胫腓联合分离或移位2至4毫米的患者可单独行清创术治疗，分离或移位4毫米及以上的患者可先行关节镜下清创复位，然后行经皮固定。经皮固定采用TightRope技术完成，该技术需要将1或2个缝线纽扣穿过胫腓骨远端的所有4个皮质。该技术用于替代传统的下胫腓联合螺钉，传统螺钉需要后续手术取出。
