临床治疗踝关节多发韧带损伤1例

2017-10-22 佚名 湖南中医杂志

患者,男,29岁。

【一般资料】

患者,男,29岁

【主诉】

因“扭伤致右踝部疼痛,肿胀,活动受限1h”于急诊就诊。

【辅助检查】

X线片及CT示:右踝关节脱位。行手法复位后X线片示:右踝关节脱位,未见腓骨高位骨折。以“右踝关节脱位”收入院治疗,入院后常规消肿,冰袋冷敷。次日行核磁检查示:(1)右踝关节脱位;(2)右下胫腓前韧带、距腓前韧带撕裂,下胫腓后韧带、三角韧带、距腓后韧带损伤。

【治疗】

患者踝部肿胀明显,予以充分消肿1周后行手术治疗。患者取仰卧位,麻醉成功后,术野消毒,铺巾,止血带止血。手法复位使脱位的腓骨复位至胫骨腓骨切迹,透视复位满意。于胫骨远端关节面以上2~3CM处,与关节面平行,由腓骨打入胫骨,向前呈30°,打通隧道后,用EndoButton固定,Cotton实验(-),闭合切口,予无菌纱布覆盖。做踝关节前内侧切口,逐层切开组织,分离并保护大隐静脉,寻找三角韧带,浅层呈扇形分开,探查无明显撕裂后切开胫后肌腱,将该肌腱移位,探查三角韧带深层,可见三角韧带深层及前关节囊撕裂,于内踝打入2枚铆钉,缝合撕裂的关节囊及三角韧带深层,闭合切口,刀口内置引流条1根,用无菌纱布覆盖。取前外侧切口,逐层切开组织,寻找距腓前韧带,探查可见距腓前韧带中部断裂,打入2枚铆钉缝合撕裂的距腓前韧带,闭合伤口,予引流条引流。术后患肢支具固定于背伸位,予以消肿、抗感染等治疗。24h内更换无菌敷料并去除引流装置,常规换药。在医师指导下进行踝关节屈伸活动。术后第45天复查,患肢肿胀已消退,无疼痛。踝关节内外侧伤口愈合良好。主动活动度背伸20°,跖屈30°,被动活动度背伸25°,跖屈40°。X线片示:踝关节术后,踝关节间隙存在。已于术后3周摘掉支具,现已能拄拐负重行走。(见图1)


版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1397351, encodeId=9019139e35161, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464007, encodeId=73bc146400e0f, content=<a href='/topic/show?id=87b99316273' target=_blank style='color:#2F92EE;'>#踝关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93162, encryptionId=87b99316273, topicName=踝关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ff6562509, createdName=qilu_qi, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507401, encodeId=47c5150e401ba, content=<a href='/topic/show?id=16b7100010c7' target=_blank style='color:#2F92EE;'>#韧带#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100010, encryptionId=16b7100010c7, topicName=韧带)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9b19890064, createdName=juliusluan81, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525810, encodeId=3c091525810cf, content=<a href='/topic/show?id=c93e228e889' target=_blank style='color:#2F92EE;'>#临床治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22878, encryptionId=c93e228e889, topicName=临床治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a68911667380, createdName=xuyong527, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255168, encodeId=a7fd255168f4, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Oct 22 21:05:55 CST 2017, time=2017-10-22, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1397351, encodeId=9019139e35161, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464007, encodeId=73bc146400e0f, content=<a href='/topic/show?id=87b99316273' target=_blank style='color:#2F92EE;'>#踝关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93162, encryptionId=87b99316273, topicName=踝关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ff6562509, createdName=qilu_qi, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507401, encodeId=47c5150e401ba, content=<a href='/topic/show?id=16b7100010c7' target=_blank style='color:#2F92EE;'>#韧带#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100010, encryptionId=16b7100010c7, topicName=韧带)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9b19890064, createdName=juliusluan81, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525810, encodeId=3c091525810cf, content=<a href='/topic/show?id=c93e228e889' target=_blank style='color:#2F92EE;'>#临床治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22878, encryptionId=c93e228e889, topicName=临床治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a68911667380, createdName=xuyong527, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255168, encodeId=a7fd255168f4, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Oct 22 21:05:55 CST 2017, time=2017-10-22, status=1, ipAttribution=)]
    2017-10-24 qilu_qi
  3. [GetPortalCommentsPageByObjectIdResponse(id=1397351, encodeId=9019139e35161, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464007, encodeId=73bc146400e0f, content=<a href='/topic/show?id=87b99316273' target=_blank style='color:#2F92EE;'>#踝关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93162, encryptionId=87b99316273, topicName=踝关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ff6562509, createdName=qilu_qi, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507401, encodeId=47c5150e401ba, content=<a href='/topic/show?id=16b7100010c7' target=_blank style='color:#2F92EE;'>#韧带#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100010, encryptionId=16b7100010c7, topicName=韧带)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9b19890064, createdName=juliusluan81, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525810, encodeId=3c091525810cf, content=<a href='/topic/show?id=c93e228e889' target=_blank style='color:#2F92EE;'>#临床治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22878, encryptionId=c93e228e889, topicName=临床治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a68911667380, createdName=xuyong527, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255168, encodeId=a7fd255168f4, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Oct 22 21:05:55 CST 2017, time=2017-10-22, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1397351, encodeId=9019139e35161, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464007, encodeId=73bc146400e0f, content=<a href='/topic/show?id=87b99316273' target=_blank style='color:#2F92EE;'>#踝关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93162, encryptionId=87b99316273, topicName=踝关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ff6562509, createdName=qilu_qi, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507401, encodeId=47c5150e401ba, content=<a href='/topic/show?id=16b7100010c7' target=_blank style='color:#2F92EE;'>#韧带#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100010, encryptionId=16b7100010c7, topicName=韧带)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9b19890064, createdName=juliusluan81, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525810, encodeId=3c091525810cf, content=<a href='/topic/show?id=c93e228e889' target=_blank style='color:#2F92EE;'>#临床治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22878, encryptionId=c93e228e889, topicName=临床治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a68911667380, createdName=xuyong527, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255168, encodeId=a7fd255168f4, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Oct 22 21:05:55 CST 2017, time=2017-10-22, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1397351, encodeId=9019139e35161, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464007, encodeId=73bc146400e0f, content=<a href='/topic/show?id=87b99316273' target=_blank style='color:#2F92EE;'>#踝关节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93162, encryptionId=87b99316273, topicName=踝关节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21ff6562509, createdName=qilu_qi, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507401, encodeId=47c5150e401ba, content=<a href='/topic/show?id=16b7100010c7' target=_blank style='color:#2F92EE;'>#韧带#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100010, encryptionId=16b7100010c7, topicName=韧带)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9b19890064, createdName=juliusluan81, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525810, encodeId=3c091525810cf, content=<a href='/topic/show?id=c93e228e889' target=_blank style='color:#2F92EE;'>#临床治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22878, encryptionId=c93e228e889, topicName=临床治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a68911667380, createdName=xuyong527, createdTime=Tue Oct 24 10:04:00 CST 2017, time=2017-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=255168, encodeId=a7fd255168f4, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Oct 22 21:05:55 CST 2017, time=2017-10-22, status=1, ipAttribution=)]
    2017-10-22 三生有幸9135

    学习一下谢谢分享

    0

相关资讯

踝关节正位-X线-解剖图片

踝关节正位-X线-解剖图片:

Medscape:踝关节治疗策略,POLICE or RICE ?

POLICE 原则:Protest 保护, Optimal Loading 合理负重, Ice 冰敷, Compression 压迫, Elevation 抬高 RICE 原则:Rest 休息, Ice 冰敷, Compression 压迫, Elevation 抬高 目前对扭伤或拉伤的治疗策略是否错误? 临床上踝关节扭伤或拉伤后需要遵循RICE原则的观念已经根深蒂固,但

漂浮体位下全踝关节松解治疗踝关节僵硬

探讨漂浮体位下圈踝关节松解治疗踝关节僵硬的临床疗效。 自2008年08月至2012年06月,对24例外伤后踝关节僵硬的患者试试漂浮体位下全踝关节松解术,即患者取侧卧摇摆漂浮体位,可通过体位的漂浮改变,同时行踝关节前方和后方的松解。术前摄踝关节X线正侧位片,了解踝关节赘的情况。测量踝关节术前的活动范围,所有患者均获得13-36个月的随访(平均24.8个月),资料完整。 有24离患者术后踝关节的活

急性踝关节三角韧带损伤的诊疗进展

作者:南华大学附属第一医院骨科  刘彬踝关节三角韧带损伤约占所有踝关节损伤的15%左右,其中内侧三角韧带损伤率远远低于外侧副韧带损伤率,约6%左右。据统计,在美国,每天大约有2700余人发生踝关节损伤,其中伴有三角韧带损伤占有5%左右。根据Lauge-Hanson分型,踝关节三角韧带主要损伤机制分为旋后外旋型、旋前外展型以及旋前外旋型,在3种损伤方式中又以旋后外旋型损伤为主,约占踝关

AOFAS 2016:与脚踝术后身体机能下降相关因素研究

AOFAS 2016年会上公布的数据显示,踝关节骨折进行手术时,增加美国麻醉医师学会(ASA)分类、BMI和患者年龄,与身体功能下降有关,且是其独立预测因素;疼痛增加与较低的BMI和更高的ASA分类有关。Daniel M. Dean博士和他的同事们对142名在2001-2013年因踝关节骨折进行手术治疗的患者进行了多中心队列研究,至少随访2年,并完成病人报告测量系统测试。研究人员称,患者的平均年龄