Newton Wellesley Hospital, Newton, MA 02462, USA.
Foot Ankle Int. 2011 Mar;32(3):250-6. doi: 10.3113/FAI.2011.0250.
Recently, a suture button device has been advocated as a simple and effective method of repairing the syndesmosis. Proponents of the device have cited earlier weightbearing and elimination of the need for device removal as potential advantages over metallic screws. However, the available reports generally have short followup. With longer followup, some concerns about the suture button device have surfaced.
We reviewed the clinical and radiographic results of 24 patients with acute injuries to the distal tibiofibular syndesmosis who were treated with suture button fixation. Average followup was 20 months. The primary outcomes measure was the AOFAS ankle hindfoot score. Secondary outcomes measures included a calibrated measurement of the tibiofibular clear space and tibiofibular overlap.
The average AOFAS score was 94 points. Syndesmotic parameters returned to normal after surgery and remained normal throughout the followup period. One in four patients required removal of the suture endobutton device due to local irritation or lack of motion. Osteolysis of the bone and subsidence of the device into the bone was observed in four patients. Three patients developed heterotopic ossification within the syndesmotic ligament, one mild, one moderate, and one who had a nearly complete syndesmotic fusion.
The suture button device is an effective way to repair the syndesmosis. In our series, the reduction of the syndesmosis was maintained throughout the followup period. However, reoperation for device removal was more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur.
最近，缝线纽扣装置已被提倡作为一种修复下胫腓联合的简单有效方法。该装置的支持者引用了更早的负重和避免需要取出装置作为潜在的优势超过金属螺钉。然而，现有的报告通常随访时间较短。随着更长时间的随访，缝线纽扣装置出现了一些令人担忧的问题。
我们回顾了 24 例急性下胫腓联合损伤患者采用缝线纽扣固定治疗的临床和影像学结果。平均随访时间为 20 个月。主要的结局测量指标是 AOFAS 踝关节后足评分。次要的结局测量指标包括胫腓骨间隙的校准测量和胫腓骨重叠。
平均 AOFAS 评分为 94 分。术后下胫腓联合参数恢复正常，随访期间一直正常。四分之一的患者因局部刺激或运动受限需要取出缝线纽扣装置。四名患者观察到骨溶解和装置下沉到骨中。三名患者在下胫腓联合韧带上出现异位骨化，一名轻度，一名中度，一名几乎完全融合。
缝线纽扣装置是修复下胫腓联合的有效方法。在我们的系列中，下胫腓联合的复位在整个随访期间得到了维持。然而，需要手术取出装置的再手术比预期的更常见。植入物附近的骨质溶解和装置下沉可能发生。
