Soin Sandeep P, Knight Trevor A, Dinah A Feroz, Mears Simon C, Swierstra Bart A, Belkoff Stephen M
Baltimore, MD, USA.
Foot Ankle Int. 2009 Apr;30(4):346-52. doi: 10.3113/FAI.2009.0346.
Flexible suture-button devices are used to stabilize the distal tibiofibular joint after syndesmotic rupture, but little is known about how they affect fibular motion during cyclic physiological loading. This study examined how much fibular motion occurs during cyclic loading of ankles repaired with suture-buttons or screws relative to one with intact ligaments.
Ten pairs of cadaveric legs with intact ligaments were tested in axial compression (750 N), external rotational torque (7.5 Nm), and a combination thereof. Fibular rotation and translation in the sagittal and frontal planes were measured with linear variable displacement transducers. Then we sectioned the anterior tibiofibular, posterior tibiofibular, deltoid, and interosseous ligaments. Ankles were repaired with suture-buttons or a 3.5-mm screw through four-cortices. The ankles were tested for 10,000 cycles using the same loading protocol. Surviving ankles were brought to failure by increasing external rotation (1 degree/sec). Data from the linear variable differential transducers were used to calculate fibular motion at 100, 1,000, 5,000, and 10,000 cycles.
There was no significant difference in the effect of the suture-button or screw for translation in the sagittal or coronal plane or for rotation about the fibular axis. The screw repair had a significantly greater (p = 0.02) failure torque (median, 26.5 Nm; inner quartile range, 25.7 to 35.2 Nm) than did the suture-button repair (median, 23.6 Nm; inner quartile range, 16.5 to 25.6 Nm).
The fibular motion that occurs during cyclic loading appears to be similar for the suture-button and syndesmotic screw. Motion in both constructs was similar, but neither restored native ankle motion.
It appears the suture-button behaves similarly to the syndesmotic screw in the syndesmotic rupture injury model tested. Clinical trials are needed to determine how the device performs in vivo.
在胫腓下联合韧带断裂后，可弯曲缝线纽扣装置用于稳定胫腓下关节，但对于其在周期性生理负荷下如何影响腓骨运动，人们了解甚少。本研究考察了在使用缝线纽扣或螺钉修复的踝关节进行周期性负荷时，相对于韧带完整的踝关节，腓骨会发生多少运动。
对10对韧带完整的尸体下肢进行轴向压缩（750 N）、外旋扭矩（7.5 Nm）以及两者联合作用下的测试。使用线性可变位移传感器测量腓骨在矢状面和额状面的旋转及平移。然后切断胫腓前韧带、胫腓后韧带、三角韧带和骨间韧带。用缝线纽扣或一枚穿过四层皮质骨的3.5毫米螺钉修复踝关节。使用相同的加载方案对踝关节进行10000次循环测试。通过增加外旋（1度/秒）使存活的踝关节失效。线性可变差动传感器的数据用于计算在100、1000、5000和10000次循环时的腓骨运动。
缝线纽扣或螺钉在矢状面或冠状面平移或围绕腓骨轴旋转方面的作用无显著差异。螺钉修复的失效扭矩（中位数，26.5 Nm；四分位间距，25.7至3 Nm）显著大于缝线纽扣修复（中位数，23.6 Nm；四分位间距，16.5至25.6 Nm）（p = 0.02）。
在周期性负荷期间发生的腓骨运动，缝线纽扣和胫腓下联合螺钉似乎相似。两种结构中的运动相似，但均未恢复踝关节的自然运动。
在所测试的胫腓下联合韧带断裂损伤模型中，缝线纽扣的表现似乎与胫腓下联合螺钉相似。需要进行临床试验以确定该装置在体内的性能。
