Haynes Jacob, Cherney Steven, Spraggs-Hughes Amanda, McAndrew Christopher M, Ricci William M, Gardner Michael J
Washington University School of Medicine, St. Louis, Missouri, USA.
Washington University School of Medicine, St. Louis, Missouri, USA
Foot Ankle Int. 2016 Jul;37(7):722-9. doi: 10.1177/1071100716634791. Epub 2016 Feb 25.
The distal tibiofibular syndesmosis is disrupted in up to 45% of operatively treated ankle fractures, and syndesmotic malreduction has historically been correlated with poor outcome. The purpose of this study was to quantify the clamp force used during syndesmotic reduction and to evaluate the effect of clamp force on fibular overmedialization (overcompression) at the level of the distal tibiofibular syndesmosis.
A prospectively recruited cohort of 21 patients underwent operative syndesmotic reduction and fixation. A ball point periarticular reduction forceps that was modified to include a load cell in one tine was used for the reduction, and the clamp force required for reduction was measured. Patients underwent postoperative bilateral computed tomographic scans of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control. Side-to-side differences in fibular medialization, translation, and rotation within the tibial incisura were measured. These findings were correlated with the reduction clamp force utilized to obtain the reduction.
Syndesmotic overcompression (fibular medialization greater than 1.0 mm when compared with noninjured ankle) was seen in 11 of 21 patients (52%). Increased clamp force significantly correlated with syndesmotic overcompression. The mean reduction clamp forces were 88 N for the undercompressed group, 130 N for the adequately compressed group, and 163 N for the overcompressed group.
This study demonstrated a significant correlation between increased clamp forces and syndesmotic overcompression, and determined objective forces that lead to overcompression. Our results indicate that surgeons should be cognizant of the clamp force used for syndesmotic reduction.
Level III, case-control series, in accordance with STROBE guidelines.
在接受手术治疗的踝关节骨折中，高达45%的患者存在下胫腓联合损伤，且从历史上看，下胫腓联合复位不良与预后不佳相关。本研究的目的是量化下胫腓联合复位过程中使用的夹钳力，并评估夹钳力对下胫腓联合水平腓骨过度内移（过度压缩）的影响。
前瞻性招募了21例患者，对其进行下胫腓联合复位及固定手术。使用一种经过改良的球头关节周围复位钳，该钳在一个钳尖中包含一个测力传感器用于复位，并测量复位所需的夹钳力。患者术后接受双侧踝关节和后足的计算机断层扫描以评估下胫腓联合复位情况。将未受伤的肢体作为对照。测量胫骨切迹内腓骨内移、平移和旋转的双侧差异。将这些结果与用于实现复位的复位夹钳力相关联。
21例患者中有11例（52%）出现下胫腓联合过度压缩（与未受伤的踝关节相比，腓骨内移大于1.0mm）。夹钳力增加与下胫腓联合过度压缩显著相关。压缩不足组的平均复位夹钳力为88N，压缩适当组为130N，过度压缩组为163N。
本研究表明夹钳力增加与下胫腓联合过度压缩之间存在显著相关性，并确定了导致过度压缩的客观力值。我们的结果表明，外科医生应注意下胫腓联合复位时使用的夹钳力。
根据STROBE指南，为III级，病例对照系列研究。
