【摘要】 目的 探讨基于三维立体观念下对踝关节骨折伴有下胫腓联合损伤的诊断及治疗的指导。方法 选择泉州市正骨医院2022年1月—2023年12月采用基于三维立体观念下指导手术治疗Denis-Weber分型中B型及C型踝关节骨折伴有下胫腓联合损伤患者76例，其中B型53例、C型23例。术中先行外踝、后踝内固定，再行内踝内固定，最后行下胫腓联合内固定。结果 所有患者术后伤口均Ⅰ期愈合，无失访，随访时间平均13个月。X线片检查示骨折均于术后3～6个月愈合，平均4.3个月。术后1个月，3例出现足趾马缰绳畸形症状；1例术后外踝外旋，下胫腓间隙增宽；1例陈旧性踝关节骨折术后出现外踝内旋伴下胫腓联合间隙增宽。末次随访时，有5例行走时出现踝关节轻度疼痛不适。根据美国矫形足踝协会（American orthopaedic foot&ankle society,AOFAS）踝与后足评分标准进行功能评估，本组评分为68～100分，平均（85.60±4.14）分；获优50例，良21例，中5例，优良率为93.4%。结论 基于三维立体观念，能让人们在判断下胫腓联合中认识更全面，更减少下胫腓联合处理的失误。更多还原

【Abstract】 Objective To investigate the guiding role of a threedimensional(3D) imaging-based approach in the diagnosis and treatment of ankle fractures combined with distal tibiofibular syndesmosis injuries. Methods This retrospective study selected 76 patients with Denis-Weber Type B and C ankle fractures combined with distal tibiofibular syndesmosis injuries, who underwent surgery guided by a 3D imaging-based approach at Quanzhou Orthopedic-Traumatological Hospital from January 2022 to December 2023. Of these, 53 cases were Type B and 23 cases were Type C. During the operation, internal fixation was performed sequentially: first for the lateral and posterior malleoli, followed by the medial malleolus, and finally for the distal tibiofibular syndesmosis. Results All patients achieved primary wound healing and were successfully followed up, with an average follow-up time of 13 months. X-ray examinations showed that all fractures healed within 3 to 6 months post-operation, averaging 4.3 months. One month post-operation, a total of 3 cases presented with symptoms of toe horse rein deformity. One case exhibited external rotation of the lateral malleolus and widened distal tibiofibular syndesmotic space. Another case of old ankle fracture showed internal rotation of the lateral malleolus accompanied by a widened distal tibiofibular syndesmotic space post-operation. At the last follow-up, a total of 5 patients experienced mild ankle pain and discomfort during walking. Functional assessment was conducted using the American Orthopaedic Foot & Ankle Society(AOFAS) ankle-hindfoot score. The scores for this group ranged from 68 to 100 points, with an average of(85.60 ± 4.14) points. Fifty cases were rated excellent, 21 good, and 5 fair, yielding an excellent and good rate of 93.4%. Conclusion A 3D imaging-based approach facilitates a more comprehensive understanding and assessment of distal tibiofibular syndesmosis injuries, which can help reduce treatment errors.更多还原