Northwestern Department of Orthopaedic Surgery, 676 N. Saint Clair, Suite 1350, Chicago, IL 60611, USA.
Foot Ankle Int. 2010 Jan;31(1):69-75. doi: 10.3113/FAI.2010.0069.
BACKGROUND: The treatment of ankle fractures with syndesmotic injuries associated with disruption of the deltoid ligament complex is controversial. The purpose of this study was to compare both the biomechanical and physiologic properties of suture-button fixation to the intact syndesmosis and screw fixation. MATERIALS AND METHODS: Eight fresh frozen human cadaveric ankles were used in three different groups. One group had an intact syndesmosis and deltoid ligamentous complex and two groups had fixation of the syndesmosis after its disruption along with disruption of the deltoid ligaments. One fixation group used a suture-button and the other used a 3.5-mm tricortical syndesmotic screw. The syndesmotic gap after cycling at submaximal loads, laxity due to cycling, and fibular movement allowed in the sagittal plane were all measured and analyzed for statistical significance. RESULTS: The syndesmotic gap after cycling was not significantly different between the intact group (9.1 mm) and the suture-button group (8.8 mm) (p = 0.1509). The screw fixation group had a significantly smaller gap (7.9 mm) as compared to the other two groups (screw versus intact, p = 0.00004; screw versus suture-button, p = 0.0004). The intact group did not demonstrate a significant difference in laxity before (9.0 mm) and after (9.1 mm) cycling (p = 0.0670), whereas the suture-button group did have a significant difference (before, 8.01 mm; after, 8.28 mm) (p = 0.000251). The movement of the fibula in the sagittal plane was significantly greater in the suture-button group (3.17 mm) as compared to the intact group (2.77 mm) (p = 0.00554). Screw fixation allowed significantly less fibular movement in the sagittal plane (1.16 mm) as compared to the intact (p = 0.00014) and suture-button (p = 0.0000012) groups. CONCLUSION: Suture-button fixation maintained reduction after cycling with submaximal loads that compared favorably to the intact syndesmosis. It also allowed more physiologic movement of the fibula in the sagittal plane when compared to tricortical screw fixation. CLINICAL RELEVANCE: Syndesmotic injury fixation has traditionally used screws to provide a rigid construct in which healing can take place. We believe a less rigid fixation method, such as suture-button fixation, provides a more physiologic type of healing of the syndesmosis.
背景：踝关节骨折伴下胫腓联合损伤和三角韧带复合体断裂的治疗存在争议。本研究的目的是比较缝线纽扣固定与完整下胫腓联合以及螺钉固定的生物力学和生理特性。
材料和方法：8 个新鲜冷冻的人尸体踝关节被分为三组。一组为完整的下胫腓联合和三角韧带复合体，两组为下胫腓联合和三角韧带断裂后固定。一组固定使用缝线纽扣，另一组使用 3.5mm 皮质骨螺钉。在亚最大负荷下循环后测量并分析下胫腓联合间隙、因循环而导致的松弛度以及矢状面腓骨活动度，并进行统计学分析。
结果：循环后下胫腓联合间隙在完整组（9.1mm）和缝线纽扣组（8.8mm）之间无显著差异（p=0.1509）。与其他两组相比，螺钉固定组的间隙明显较小（螺钉固定组 7.9mm）（螺钉固定组与完整组，p=0.00004；螺钉固定组与缝线纽扣组，p=0.0004）。完整组在循环前后松弛度无显著差异（循环前 9.0mm，循环后 9.1mm）（p=0.0670），而缝线纽扣组有显著差异（循环前 8.01mm，循环后 8.28mm）（p=0.000251）。缝线纽扣组腓骨在矢状面的运动明显大于完整组（3.17mm 比 2.77mm）（p=0.00554）。与完整组（p=0.00014）和缝线纽扣组（p=0.0000012）相比，螺钉固定组允许腓骨在矢状面的运动明显减少（1.16mm）。
结论：缝线纽扣固定在亚最大负荷下循环后能维持复位，与完整的下胫腓联合相比效果良好。与皮质骨螺钉固定相比，缝线纽扣固定还允许腓骨在矢状面有更多的生理性运动。
临床相关性：下胫腓联合损伤固定传统上使用螺钉来提供刚性结构，以便愈合。我们认为，一种较不刚性的固定方法，如缝线纽扣固定，可以提供一种更生理性的下胫腓联合愈合方式。
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