The distal tibiofibular syndesmosis is a critical structure in maintaining the ankle stability. Syndesmotic in-juries are usually associated with ankle fractures and high fibula fractures.Non-isolated and partially isolated syndesmotic in-juries are involved in unstable injuries,which need to operative treatment.Partially isolated syndesmotic injuries belong to sta-ble injuries,which should be treated with non-operative management.It is becoming clear that early fixation and stabilization for unstable injuries are probably better than non-treatment or delayed treatment.It still remains without consensus of accurate-ly defining stable from unstable injuries and sufficiently differentiating between acute and chronic injuries.Because of stabili-ty,fixation type,and duration,the clinical efficacy is different.Screw fixation is a gold standard treatment of syndesmotic in-jury.However,it remains controversial that whether removal of the syndesmotic screw is required and effect of the level of syn-desmotic screw insertion,limited micro-movement is one of disadvantages of screw fixation. Micro-movement of the distal tibiofibular syndesmosis has been paid more and more attention.Dynamic fixation is a viable alternative to the static fixation device,with lower re-operation rates and less complications,which has obtained a great short-term clinical efficacy.However, further long-term studies should be carried out to confirm this clinical efficacy.Optimized treatment strategies considering sta-bility of syndesmotic injury,duration,and fixation type can help to improve clinical efficacy.%下胫腓联合是稳定踝关节的重要结构,其损伤常合并踝关节和腓骨高位骨折,少数情况可单独发生.非稳定性损伤见于非单纯性及部分单纯性下胫腓联合损伤,需早期手术治疗.稳定性损伤见于部分单纯性下胫腓联合损伤,可选择保守治疗.早期治疗和稳定下胫腓联合损伤比不治疗,延迟治疗能取得更好的临床疗效.目前单纯性下胫腓联合损伤的稳定性及急慢性诊断一直存在争议,下胫腓联合损伤的稳定性、损伤时间、固定类型可影响下胫腓联合损伤的临床疗效.手术治疗可选择螺钉固定和弹性固定.螺钉固定是治疗下胫腓联合损伤的金标准,但其螺钉是否拔除、置入位置等技术细节一直是争议的焦点,其缺点是可限制下胫腓联合微动等.保留下胫腓联合微动机制日益受到重视,弹性固定可作为一种螺钉替代治疗方式,已经取得较好的短期疗效,但长期临床疗效和是否需要加压固定等方面需进一步研究确定.下胫腓联合损伤的治疗需要根据其稳定性、损伤时间、固定类型等方面进行合理选择,有利于提高临床疗效.
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