Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA.
J Bone Joint Surg Am. 2012 Dec 19;94(24):2256-61. doi: 10.2106/JBJS.K.01726.
Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimize forceps reductions to restore syndesmotic relationships accurately have not been systematically studied. The purpose of the present study was to evaluate the accuracy of syndesmosis reduction with different rotational vectors of clamp placement.
Ten through-the-knee cadaveric specimens were used. Markers were placed on the tibia and fibula to produce consistent clamp placement and radiographic evaluation. A computed tomographic scan of the ankle was made to serve as a control, followed by a stepwise destabilization of the anterior inferior tibiofibular ligament, syndesmosis, deltoid ligament, small posterior malleolus fracture, and large posterior malleolus fracture. Following each step in the destabilization, clamps were applied to compress the syndesmosis at varying angles and computed tomography was performed to measure the alignment of the syndesmosis as compared with that on the control scan.
In all degrees of induced instability, and for all vectors of clamp placement, a small but consistent amount of overcompression of the syndesmosis was observed. The average overcompression (and standard deviation) for all samples was 0.93 ± 0.70 mm. Both obliquely oriented clamp arrangements consistently caused fibular malreductions in the sagittal plane. Placing the clamp in the neutral anatomical axis reduced the syndesmosis most accurately, with an average displacement of 0.1 ± 0.77 mm compared with control through all degrees of instability.
Clamp placement in the neutral anatomical axis reduced the syndesmosis most accurately in our cadaveric model, although slight overcompression was frequently observed. Placing the clamp obliquely malreduced the unstable syndesmosis.
最近的研究表明，准确地减少和评估踝关节损伤后距骨下关节的复位是困难的。距骨下关节通常通过使用复位夹来压缩胫骨和腓骨来复位。然而，尚未系统地研究优化夹复位以准确恢复距骨下关节关系的术中技术。本研究的目的是评估不同夹放置旋转矢量对距骨下关节复位的准确性。
使用 10 个全膝关节尸体标本。在胫骨和腓骨上放置标记物以产生一致的夹放置和放射照相评估。对踝关节进行 CT 扫描作为对照，然后逐步破坏下胫腓前韧带、距骨下关节、三角韧带、后踝小骨折和后踝大骨折。在不稳定的每一步之后，在不同角度施加夹以压缩距骨下关节，并进行 CT 扫描以测量距骨下关节的对准情况与对照扫描相比。
在所有诱导不稳定的程度和所有夹放置的矢量中，观察到距骨下关节的轻微但一致的过度压缩。所有样本的平均过度压缩（和标准差）为 0.93 ± 0.70 毫米。斜向夹布置始终导致腓骨在矢状面上复位不良。将夹放置在中立解剖轴上可最准确地减少距骨下关节，与所有不稳定程度的对照相比，平均位移为 0.1 ± 0.77 毫米。
在我们的尸体模型中，夹放置在中立解剖轴上可最准确地减少距骨下关节，尽管经常观察到轻微的过度压缩。斜向夹放置会使不稳定的距骨下关节复位不良。
