Sugimoto K, Samoto N, Takaoka T, Takakura Y, Tamai S
Department of Orthopaedic Surgery, Saiseikai Nara Hospital, Japan.
J Bone Joint Surg Br. 1998 Sep;80(5):785-90. doi: 10.1302/0301-620x.80b5.7921.
We treated 43 acute tears of the calcaneofibular ligament by operation in 43 patients after subtalar arthrography. There were 22 men and 21 women with a mean age of 22.3 years (14 to 61). Anteroposterior (AP), lateral and oblique views were obtained with the foot in 45 degrees of internal rotation and the ankle in the neutral position. Any communication or leakage to the ankle, tendon sheaths, subcutaneous tissue and sinus tarsi was recorded. We examined an oblique view of the microrecess along the interosseous ligament and an AP view of the lateral recess just under the distal end of the fibula. We also studied a control group of 27 patients with isolated injuries of the anterior talofibular ligament without rupture of the calcaneofibular ligament. The findings in the two groups were significantly different when examined for leakage to the ankle (p=0.0002), to the peroneal tendon sheaths (p=0.0347) and to the subcutaneous tissue (p=0.0222), absence of the microrecess (p=0.0055) and presence of the lateral recess (p=0.0012). Many ankle sprains which involve tearing of the calcaneofibular ligament are accompanied by injuries of the subtalar joint. Combined injuries of the anterior talofibular ligament and calcaneofibular ligament, and isolated injury of the anterior talofibular ligament should be differentiated.
我们在43例患者行距下关节造影后，对43例跟腓韧带急性撕裂进行了手术治疗。其中男性22例，女性21例，平均年龄22.3岁（14至61岁）。在足部内旋45度且踝关节处于中立位时拍摄前后位（AP）、侧位和斜位片。记录造影剂向踝关节、腱鞘、皮下组织和跗骨窦的任何相通或渗漏情况。我们检查了沿骨间韧带的微凹陷斜位片以及腓骨远端下方外侧凹陷的前后位片。我们还研究了一个对照组，该组有27例单纯前距腓韧带损伤且跟腓韧带未断裂的患者。在检查造影剂向踝关节渗漏（p = 0.0002）、向腓骨肌腱腱鞘渗漏（p = 0.0347）和向皮下组织渗漏（p = 0.0222）、微凹陷缺失（p = 0.0055）以及外侧凹陷存在（p = 0.0012）时，两组的结果存在显著差异。许多涉及跟腓韧带撕裂的踝关节扭伤都伴有距下关节损伤。应区分前距腓韧带和跟腓韧带的联合损伤以及单纯前距腓韧带损伤。
