骨科英文书籍精读（369）｜腓骨肌腱脱位
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TEARS OF INFERIOR TIBIOFIBULAR LIGAMENTS
The inferior tibiofibular ligaments may be torn, allowing partial or complete separation of the tibiofibular joint (diastasis). Complete diastasis, with tearing of both the anterior and posterior fibres, follows a severe abduction strain. Partial diastasis, with tearing of only the anterior fibres, is due to an external rotation force. These injuries may occur in isolation, but they are usually associated with fractures of the malleoli or rupture of the collateral ligaments.
Clinical features
Following a twisting injury, the patient cmplains of pain in the front of the ankle. There is swelling and marked tenderness directly over the inferior tibiofibular joint. A 'squeeze test’ has been described by Hopkinson et al. (1990); when the leg is firmly compressed some way above the ankle, the patient experiences pain over the syndesmosis. Be sure, though, to exclude a fracture before carrying out the test.
X-ray
With a partial tear the fibula usually lies in its normal position and the x-ray looks normal. With a complete tear the tibiofibular joint is separated and the ankle mortise is widened; sometimes this becomes apparent only when the ankle is stressed in abduction. There may be associated fractures of the distal tibia or fibula, or an isolated fracture more proximally in the fibula.
Treatment
Partial tears can be treated by strapping the ankle firmly for 2–3 weeks. Thereafter exercises are encouraged. Complete tears are best managed by internal fixation with a transverse screw just above the joint. This must be done as soon as possible so that the tibiofibular space does not become clogged with organizing haematoma and fibrous tissue. If the patient is seen late and the ankle is painful and unstable, open clearance of the syndesmosis and transverse screw fixation may be warranted. The ankle is immobilized in plaster for 8 weeks, after which the screw is removed. However, some degree of instability usually persists.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
inferior /ɪnˈfɪriər/adj. 差的；自卑的；下级的，下等的n. 下级；次品
inferior tibiofibular ligaments下胫腓联合韧带
diastasis/dai'æstəsis/n. 分离；心舒张后期
squeeze test挤压试验
syndesmosis. /ˌsɪndesˈmoʊsɪs/n. [解剖] 韧带联合
Be sure, though, to exclude a fracture before carrying out the test.不过，在进行测试之前，一定要排除骨折。
ankle mortise踝穴
/ˈmɔːrtɪs/n. 榫眼
strap /stræp/n. 带子，皮带，金属带；鞭打v. 用带捆绑，用带固定；包扎；鞭打
Thereafter exercises are encouraged.此后鼓励锻炼。
be clogged with organizing haematoma and fibrous tissue被血肿和纤维组织堵塞
organizing /'ɔɡənaɪzɪŋ/v. 组织（organize的ing形式）；使有机化n. 组织
warranted /'wɔrənt/adj. 保证的；担保的v. 批准（warrant的过去分词）；授权
The ankle is immobilized in plaster for 8 weeks, after which the screw is removed.用石膏固定踝关节8周，然后取出螺钉。
有道翻译（仅供参考，建议自己翻译）：
胫腓下韧带撕裂
下胫腓韧带可能撕裂，导致胫腓关节部分或完全分离（分离）。严重的外展劳损导致完全分离，前后纤维撕裂。部分分离，只有前纤维撕裂，是由于外部旋转力。这些损伤可能单独发生，但通常与踝关节骨折或副韧带断裂有关。
临床特征
扭伤后，病人的脚踝前部开始疼痛。下胫腓关节正上方有肿胀和明显压痛。Hop kinson等人（1990）描述了“挤压试验”；当腿被牢牢地压缩到脚踝以上的某个位置时，b患者会经历联会疼痛。不过，在进行测试之前，一定要排除骨折。
X射线
当腓骨部分撕裂时，腓骨通常处于正常位置，x光片显示正常。完全撕裂时，胫腓关节分离，踝榫加宽；有时只有当脚踝在外展时受到压力时，这才变得明显。可能有胫骨或腓骨远端相关骨折，或腓骨近端孤立性骨折。
治疗
部分撕裂可以用绷带固定脚踝2-3周来治疗。此后，运动被鼓励。完全撕裂最好是在关节上方用横向螺钉内固定。必须尽快这样做，以免胫腓骨间隙被组织性血肿和纤维组织堵塞。如果患者就诊较晚，且踝关节疼痛不稳，则应开放清除联合，并采用横向螺钉固定。踝关节用石膏固定8周，然后取下螺钉。然而，某种程度的不稳定通常持续存在。