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正常踝关节及常见病变的影像学诊断
踝关节(ankle joint)是全身第三大持重关节,由胫骨下端和内、外踝构成的踝穴及距骨体共同组成榫眼状关节.踝关节周围有坚强的韧带固定,有趾、拇屈、伸肌腱、腱鞘及胫前后动脉环抱(包绕).踝关节与距跟舟关节互有韧带连接,互相协调活动,因此,踝关节是运动创伤、肌腱、腱鞘磨损、关节退变、骨折脱位和感染病变的好发部位[1].
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后踝骨折分型及治疗的研究进展
后踝在维持踝关节的稳定性与功能方面发挥重要的作用，后踝骨折约占踝关节损伤的7%~44%。研究显示，当踝关节骨折累及后踝时，其治疗效果通常不能令人满意，骨折复位不良可导致畸形愈合、疼痛和活动受限等并发症，症状明显者还需行截骨矫形手术。Haraguchi等将后踝骨折分为三型：Ⅰ型，后外斜型；Ⅱ型，内侧延伸型；Ⅲ型，小壳型（小片剥脱型）。Mangnus等认为可将后踝骨折分为两个基本类型：后外型和后内型。Bartonícek等在CT扫描和三维重建的基础上，根据骨块位置、形状、大小和胫骨腓切迹完整性等因素，将后踝骨折分为四型：Ⅰ型，切迹外骨折；Ⅱ型，后外侧骨折；Ⅲ型，后踝两部分骨折；Ⅳ型，后外侧大三角形骨折。后踝骨折的形态在个体间差异较大，目前尚没有一种被普遍接受的分型方法能够充分体现骨折的受伤机制和损伤程度，并对治疗有指导意义。骨折块的大小仍然是决定后踝骨折是否需行内固定术的重要因素，患者伤后应摄踝关节正、侧位X线片，以了解踝关节骨折、脱位和韧带损伤等情况，同时通过CT及三维重建对后踝骨折块的形态、大小、移位程度等进行详细地术前评估和计划，确定适宜的手术入路，如踝关节后外侧入路、后内侧入路或后外侧与后内侧联合入路，并根据骨折块的大小选择螺钉或钢板内固定，以达到后踝骨折解剖复位、恢复关节面的平整以及胫距关节和下胫腓联合稳定性的治疗目的。
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急性踝关节扭挫伤的处理与预防
发生急性踝关节扭挫伤后,局部肌肉、韧带及肌腱等软组织会有不同程度的撕裂和毛细血管破裂出血,导致局部出现淤血斑、肿胀、疼痛、功能障碍等.此时切记不要立即进行按摩、热敷或贴敷活血止痛药膏,否则会使局部受伤部位的毛细血管扩张和血液循环加快,从而加重局部出血和肿胀,并且使疼痛加重.
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气针加手法治疗急性踝关节扭挫伤90例
BACKGROUND: Air acupuncture therapy is to make use of time and space stimuli of air in acupoint and promote blood circulation to remove blood stasis, relieve swelling and pain through interstitial osmosis and absorption. Manipulation to acute sprain and bruising of ankle joint can achieve anatomic reduction as soon as possible, clear incarceration of synovium, promote circulation of qi and relieve pain and increase blood circulation of affected tissue.
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胫腓骨骨折术后分期康复治疗效果分析
Background: Joint movement disorder and even stiff joint often occurs after external fixation for fracture of tibia and fibula, the reason of which is usually the intra joint adherence and the adherence and atrophy of the extra joint muscles. Objective: To discuss the treatment effects of post- operational staged rehabilitation for fracture of tibia and fibula. Unit: Second People Hospital of Ningxia. Subject: There were 65 cases including 45 male and 20 female ones. They were from 16～ 70 years with the average of 43 years. The fractures were all unstable, fragmental and open. Intervention: Three- staged rehabilitation was applied after external fixation: (1) Early rehabilitation treatment (3～ 6 weeks after operation): ① The fractured limb was elevated to diminish the swelling; ② To exercise the joints at the end of the limbs, as to exercise the toes for multiple times every day; ③ Fix the muscles of the limbs and contract them isometricly, do it for 15～ 20 minutes each time and for multiple times every day. (2) Middle rehabilitation treatment(8～ 10 weeks after operation ) muscle force exercises were increased gradually, the anti resistance exercises were added gradually after the muscle force got over degree III, the joint movement ranges were added gradually with the muscle under control. (3) Late rehabilitation treatment ( the fracture had healed).① Muscle force exercises: Anti resistance exercises such as sandbag kicking and pedaling. ② Joint movement exercises including active and passive exercises, such as extension and flexion of knee joint, dorsiextension and planter flexion of ankle joint, the exercises should be increased gradually to form some rhythm and speed. Also electric treatment, heat treatment, ultrasonic treatment and massage etc may be added in this period. Result: The follow up periods for the 65 cases were 3～ 12 months and the time for the fractures to heal completely was 8～ 16 weeks ( the average was 12 weeks). The function condition of the ankle and knee joints was as follows: knee flexion 150° , knee extension 0° ; ankle dorsiflexion 20° , ankle planter flexion 40° , ankle inversion 30° , ankle extroversion 20° . Conclusion: Manipulative reduction combined with rehabilitation exercises may have excellent effects on facture of tibia and fibula.
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矩形弹性髓内钉治疗胫腓骨骨折配合术后康复锻炼对膝踝关节功能恢复的影响
Background: The bony union phase is long in the fracture of tibia and fibula. The fixation will have an effect on the function of knee joint and ankle joint inevitably after a long duration. Using rectangular elastic intramedullary nail plus proper rehabilitation exercises after surgery achieved rather satisfying effect on the functional restoration of knee joint and ankle joint.
