Kwaadu Kwasi Yiadom, Fleming Justin James, Salmon Trudy
Assistant Professor, Temple University School of Podiatric Medicine, Philadelphia, PA.
Fellowship Director, Philadelphia Foot and Ankle Fellowship, The Muscle, Bone, and Joint Center, Philadelphia, PA; Podiatric Residency Director, Aria Health Systems, Philadelphia, PA.
J Foot Ankle Surg. 2015 Sep-Oct;54(5):773-81. doi: 10.1053/j.jfas.2014.12.017. Epub 2015 Feb 28.
Ankle fractures are very common, and although algorithms are in place for osseous management, consensus has not been reached regarding treatment of associated ligamentous injuries. Although tibiofibular syndesmotic stabilization can be done using different forms of fixation, the biomedical literature has long emphasized the risk of long-term restriction of ankle mobility with the use of lagged transfixation. However, when reduction cannot be maintained with positional fixation, we found that lagging the syndesmotic screw helped to maintain the reduction without causing functional restriction. In this report, we describe our experience with patients who had undergone lagged tibiofibular transfixation and were available for short- to intermediate-term follow-up to assess ankle function. A total of 31 patients (32.63% of 95 consecutive patients) were available at a mean of 34.87 (range 18 to 52) months to complete the American Orthopedic Foot and Ankle Society ankle-hindfoot questionnaire. The mean score was 88.38 (range 42 to 100) points at a mean follow-up interval of 34.87 (range 18 to 52) months. Of 31 patients, 19 had an AOFAS score of 90 points, 9 an AOFAS score of 80 to 89 points, 2 an AOFAS score of 60 to 69 points, and 1 an AOFAS score of <60 points. Because all syndesmotic screws were placed using the lag technique, unrestricted motion compared with the uninjured limb was used as the endpoint. All subjects had unrestricted motion compared with the uninjured limb, refuting the assertion that lagged syndesmotic screw fixation confers more restriction in ankle kinematics than positional syndesmotic fixation.
踝关节骨折非常常见，尽管已经有针对骨性结构处理的相关算法，但对于伴发的韧带损伤的治疗尚未达成共识。虽然胫腓联合固定可以采用不同的固定方式，但生物医学文献长期以来一直强调使用拉力螺钉固定会有导致踝关节活动长期受限的风险。然而，当通过位置固定无法维持复位时，我们发现使用拉力螺钉固定胫腓联合会有助于维持复位且不会导致功能受限。在本报告中，我们描述了对接受拉力胫腓联合固定且可进行短期至中期随访以评估踝关节功能的患者的治疗经验。共有31例患者（占95例连续患者的32.63%）在平均34.87个月（范围18至52个月）时可完成美国矫形足踝协会的踝-后足问卷。在平均随访间隔34.87个月（范围18至52个月）时，平均得分为88.38分（范围42至100分）。31例患者中，19例美国矫形足踝协会评分为90分，9例评分为80至89分，2例评分为60至69分，1例评分为低于60分。由于所有胫腓联合螺钉均采用拉力技术置入，因此将与未受伤肢体相比的无限制活动作为终点指标。与未受伤肢体相比，所有受试者均有不受限的活动，这反驳了拉力胫腓联合螺钉固定比位置性胫腓联合固定在踝关节运动学上造成更多限制的观点。
