目的 探讨踝关节镜在Danis-Weber B型踝关节骨折合并下胫腓联合损伤诊断中的价值.方法 2014年8月至2018年1月收治Danis-WeberB型踝关节骨折52例,男31例,女21例,年龄(35.37±11.19)岁(范围18～67岁).术前根据临床表现、影像学检查、X线透视下Cotton试验及外旋试验判断是否合并下胫腓联合损伤.行切开复位内固定,有三角韧带损伤的24例用3.5 mm带线锚钉缝合修复.于踝关节镜直视下评估Cotton试验、外旋试验时下胫腓联合损伤情况,对确定合并下胫腓联合损伤者在骨折内固定后以TightRope修复.术后12个月随访,以疼痛视觉模拟评分(visual analoguescale,VAS)、美国矫形外科足踝协会(American Orthopedic Foot & Ankle Society,AOFAS)评分、Baird-Jackson评分评估疼痛症状缓解及踝关节功能情况.结果 术前X线检查提示合并下胫腓联合损伤19例(36.5％,19/52)、CT提示下胫腓联合损伤28例(53.8％,28/52)、MRI提示下胫腓联合损伤39例(75.0％,39/52),踝关节镜下发现下胫腓联合损伤36例(69.2％,36/52).TightRope修复下胫腓联合损伤后,镜下评估下胫腓联合均完全复位并稳定.术后12个月VAS评分由术前(8.13±1.32)分下降至(0.75±0.73)分,AOFAS和Baird-Jackson评分分别由术前(26.59±3.35)分、(16.44±3.63)分提高至(94.36±3.03)分、(90.29±6.45)分,手术前后的差异均有统计学意义(P＜0.05).其中无合并下胫腓韧带损伤的16例术后VAS评分、AOFAS评分、Baird-Jackson评分分别为(0.58±0.67)分、(95.27±4.67)分、(91.98±9.23)分.结论 踝关节镜检查能直视观察下胫腓联合损伤情况,下胫腓联合损伤诊断阳性率达69.2％,对选择术式和评估下胫腓联合修复效果具有指导意义.%Objective To investigate clinical value of ankle arthroscopy in diagnosis of type Danis-Weber B ankle fracture with the distal tibiofibular syndesmosis injury.Methods From August 2014 to January 2018,a total of 52 cases of type Danis-Weber B ankle fractures with an average age of 35.37± 11.19 years,including 31 males and 21 females were treated.Each patient underwent preoperative assessment,according to the patient's clinical manifestations and imaging examination before operation.The Cotton test and the external rotation test were conducted in the C arm X-ray to evaluate whether there is the distal tibiofibular syndesmosis injury.All fractures were treated with open reduction and internal fixation.Repair was conducted with 3.5 mm wire anchor and nail for triangular ligament injury.The Cotton test and external rotation test were performed under ankle arthroscopy.The injury of the lower tibiofibular syndesmosis was observed and evaluated by cotton test and external rotation test in patients who were found to be associated with lower tibiofibular joint injury.After internal fixation of fracture and repair of tibiofibular syndesmosis injury with TightRope,the repair effects of tibiofibular syndesmosis injury was observed under direct vision of ankle arthroscopy.The VAS score,AOFAS score and Baird-Jackson score was used as an index to observe the pain and ankle function before and after operation for 12 months follow-up.Results Preoperative X-ray showed 19 cases of lower tibiofibular joint injury.Preoperative CT showed 28 cases of lower tibiofibular joint injury.Preoperative MRI showed 39 cases of lower tibiofibular joint injury.A total of 36 cases of joint injury of lower tibiofibular syndesmosis were confirmed under arthroscopy of ankle.After repair of tibiofibular syndesmosis injury with TightRope,complete reduction and stability of inferior tibiofibular syndesmosis were confirmed under ankle arthroscopy.At 12 months after operation,the VAS score decreased from 8.13 ± 1.32 points preoperation to 0.75±0.73 points after operation.The AOFAS and Baird-Jackson scores increased from 26.59±3.35 points,16.44±3.63 points preoperation to 94.36±3.03 points,90.29±6.45 points after operation,respectively.There was significant difference before and after operation (P＜0.05).The postoperative VAS score,AOFAS score and Baird-Jackson score of 16 patients without lower tibiofibular ligament injury were confirmed in the ankle arthroscopy group,namely 0.58±0.67 points,95.27±4.67 points,91.98±9.23 points.Conclusion Ankle arthroscopy can be used to observe the injury of tibiofibular syndesmosis under direct vision.The positive rate of diagnosis of inferior tibiofibular syndesmosis injury was 69.2％ (36/52).It can provide reliable evidence for correct diagnosis and treatment of type Danis-Weber B ankle fracture with lower tibiofibular joint injury with significant meaning in selecting operative methods and in evaluating the effect of lower tibiofibular ligament repair.
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