Schottel Patrick C, Baxter Josh, Gilbert Susannah, Garner Matthew R, Lorich Dean G
*Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT;†Department of Biomechanics, Hospital for Special Surgery, New York, NY;‡Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA; and§Department of Orthopaedic Surgery, Hospital for Special Surgery and New York Presbyterian Hospital, New York, NY.
J Orthop Trauma. 2016 Feb;30(2):e36-40. doi: 10.1097/BOT.0000000000000427.
To compare the external rotation stability of 3 different syndesmotic stabilization techniques in a cadaveric ankle fracture model.
Nondestructive external rotation stresses of 4 N·m were applied to 8 cadaveric limbs using a hydraulic loading frame. Four conditions were tested using a repeated-measures design: intact and 3 repair conditions after a destabilizing ligamentous ankle injury with syndesmotic disruption. The 3 repair conditions were tricortical trans-syndesmotic screw fixation, posterior inferior tibiofibular ligament (PITFL) repair, and combined PITFL and deltoid ligament repair. External rotation of the ankle joint and syndesmosis was measured using a motion capture system and compared for each test condition. Repeated-measures 1-way analyses of variance statistical tests were performed to compare the ankle and syndesmotic rotation findings between the 3 repair conditions and intact condition.
Rotational ankle stability was not fully restored by any of the 3 repair constructs. The intact ankle joint externally rotated approximately half as many degrees as the 3 repair conditions (intact: 10.9; trans-syndesmotic screw: 17.0; PITFL: 21.4; and PITFL/deltoid: 15.6). The intact condition also demonstrated significantly fewer degrees of syndesmotic rotation than the repair constructs (intact 2.4; trans-syndesmotic screw 5.2; PITFL 8.5; and PITFL/deltoid 6.9). Each of the repair conditions resulted in an externally rotated fibula when no loads were applied. The ligamentous repairs externally rotated the fibula twice as much as the trans-syndesmotic screw (P < 0.016).
We found that combined repair of the PITFL and deltoid ligament restores an equivalent amount of ankle and syndesmotic rotational stability when compared to trans-syndesmotic screw fixation. Based on our findings, ligamentous repair can potentially be a viable treatment alternative in unstable ankle fracture patients with syndesmotic disruption.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在尸体踝关节骨折模型中比较3种不同的下胫腓联合稳定技术的外旋稳定性。
使用液压加载框架对8具尸体下肢施加4 N·m的无损外旋应力。采用重复测量设计测试4种情况：完整状态以及踝关节韧带损伤并伴有下胫腓联合损伤后的3种修复状态。3种修复状态分别为三皮质跨下胫腓联合螺钉固定、胫腓后下韧带（PITFL）修复以及PITFL与三角韧带联合修复。使用运动捕捉系统测量踝关节和下胫腓联合的外旋情况，并对每种测试情况进行比较。进行重复测量单因素方差统计检验，以比较3种修复状态与完整状态之间的踝关节和下胫腓联合旋转结果。
3种修复结构均未完全恢复踝关节的旋转稳定性。完整踝关节的外旋角度约为3种修复状态的一半（完整：10.9°；跨下胫腓联合螺钉：17.0°；PITFL：21.4°；PITFL/三角韧带：15.6°）。完整状态下的下胫腓联合旋转角度也明显少于修复结构（完整2.4°；跨下胫腓联合螺钉5.2°；PITFL 8.5°；PITFL/三角韧带6.9°）。在未施加负荷时，每种修复状态均导致腓骨向外旋转。韧带修复使腓骨向外旋转的程度是跨下胫腓联合螺钉的两倍（P < 0.016）。
我们发现，与跨下胫腓联合螺钉固定相比，PITFL与三角韧带联合修复可恢复同等程度的踝关节和下胫腓联合旋转稳定性。基于我们的研究结果，韧带修复可能是不稳定踝关节骨折伴下胫腓联合损伤患者的一种可行治疗选择。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
