Peterson Kyle S, Chapman W Drew, Hyer Christopher F, Berlet Gregory C
Suburban Orthopaedics, Bartlett, IL, USA
Harvard Foot and Ankle, Hollywood, FL, USA.
Foot Ankle Int. 2015 Jun;36(6):679-84. doi: 10.1177/1071100715571631. Epub 2015 Feb 17.
Malreduction of the syndesmosis can lead to increased peak pressures and subsequent arthritis. The purpose of this study was to evaluate the initial syndesmotic reduction and radiographic maintenance when using a knotless suture button fixation device for treatment of syndesmotic injury.
A retrospective chart and radiographic review was performed to identify patients who underwent open reduction internal fixation of ankle syndesmosis ruptures treated with a knotless, suture button fixation system. Radiographic measurements included medial clear space, tibiofibular overlap, tibiofibular clear space, and the distance between buttons. Fifty-six patients underwent repair of an ankle fracture with syndesmotic rupture over a 3-year period, with a mean follow-up of 160.9 days.
The tibiofibular clear space and tibiofibular overlap significantly improved from pre- to first postoperative, but also demonstrated some loss of fixation at final follow-up (P < .001). The distance between the buttons increased on average 1.1 mm from immediate postoperative to final follow-up, demonstrating some postoperative creep and loss of fixation in the system. A low complication rate and need for a revision operation was found in our patient cohort. Some loss of reduction did occur postoperatively, although this did not correlate to adverse patient outcomes.
Syndesmotic stabilization, using a knotless suture button fixation device demonstrated adequate initial syndesmotic reduction, but also exhibited an increase in the tibiofibular clear space and tibiofibular overlap, relative to initial postfixation position, at short-term follow-up.
Level IV, retrospective case series.
下胫腓联合复位不良可导致峰值压力增加及后续关节炎。本研究的目的是评估使用无结缝线纽扣固定装置治疗下胫腓联合损伤时的初始下胫腓联合复位情况及影像学维持情况。
进行回顾性图表及影像学检查，以确定接受无结缝线纽扣固定系统治疗的踝关节下胫腓联合断裂切开复位内固定术的患者。影像学测量包括内侧间隙、胫腓骨重叠、胫腓间隙以及纽扣间距离。56例患者在3年期间接受了伴有下胫腓联合断裂的踝关节骨折修复术，平均随访160.9天。
胫腓间隙和胫腓骨重叠在术后首次随访时较术前显著改善，但在末次随访时也显示出一定程度的固定丢失（P < .001）。纽扣间距离从术后即刻到末次随访平均增加了1.1 mm，表明该系统存在一定的术后蠕变及固定丢失。在我们的患者队列中发现并发症发生率较低且翻修手术需求较少。术后确实出现了一些复位丢失，尽管这与不良患者预后无关。
使用无结缝线纽扣固定装置进行下胫腓联合稳定，在短期随访时显示出足够的初始下胫腓联合复位，但相对于初始固定后位置，胫腓间隙和胫腓骨重叠也有所增加。
IV级，回顾性病例系列。
