摘要
目的探讨基于踝关节水平位CT不同类型下胫腓联合分离的临床特点、手术策略及疗效。方法回顾性分析2009年1月至2016年1月收治的63例下胫腓联合损伤患者资料。自行根据踝关节水平位CT上腓骨内侧壁和胫骨外侧面切迹前、中、后3处距离不同分为旋前外旋型、旋后外旋型和外展型3种下胫腓联合分离类型，其中旋前外旋型28例，旋后外旋型11例，外展型24例。根据不同下胫腓联合分离特点采用对应复位方法和固定方式，术后12个月复位质量采用Burwell-Charnleys标准评估，踝关节功能评价采用美国足踝外科协会（AOFAS）的踝一后足评分系统。结果所有患者术后获6～48个月（平均19．3个月）随访。复位质量：旋前外旋型中解剖复位19例，复位较好7例，复位一般2例；旋后外旋型中解剖复位6例，复位较好4例，复位一般1例；外展型中解剖复位17例，复位较好6例，复位一般1例。AOFAS的踝．后足评分：旋前外旋型为88．6分，旋后外旋型为89．4分，外展型为86．6分。结论根据自行分类的下胫腓联合损伤，不同分离方式有其临床特点，根据其临床特点采用相应方法复位、固定，疗效肯定。
Objective To explore the clinical characteristics of and surgical strategies for distal tibiofibular syndesmosis separation based on ankle axial CT scan. Methods From January 2009 to January 2016, 63 patients with injury to the distal tibiofibular syndesmosis were treated. Their injuries were characterized according to the anatomic characteristics on their ankle axial CT scan images as pronation-extorsion type （28 cases）, supination-extorsion type （11 cases） and abduction type （24 cases） . Specific strategies of reduction and fixation depended on the specific characteristics of distal tibiofibular syndesmosis separation. After 12 months postoperatively, the reduction quality was assessed by Burwell-Charnley＇s radiological evaluation system and the function of ankle joint was assessed using American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot score system. Results The patients were followed up for 6 to 48 months （average, 19.3 months）. Anatomical reduction was achieved in 19 cases, good reduction in 7 and fair re- duction in 2 in the pronation-extorsion type, yielding an excellent to good rate of 92. 8% ; anatomical reduc- tion was achieved in 6 cases, good reduction in 4 and fair reduction in one in the supination-extorsion type, yielding an excellent to good rate of 90.9%; anatomical reduction was achieved in 17 cases, good reduction in 6 and fair reduction in one in the abduction type, yielding an excellent to good rate of 95.8%. By the AOFAS system, the pronation-extorsion type scored 88.6 points, the supination-extorsion type 89.4 points and the abduction type 86.6 points. Conclusion In the treatment of distal tibiofibular syndesmosis separation, reduction and fixation strategies should depend on analysis of the characteristics on the ankle axial CT scan, so as to achieve positive outcomes.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第12期1036-1045,共10页
Chinese Journal of Orthopaedic Trauma
关键词
踝关节
体层摄影术
螺旋计算机
创伤和损伤
下胫腓联合分离
Ankle joint
Tomography, spiral computed
Wounds and injuries
Distal tibiofibular syndesmosis separation
