Steinmetz S, Puliero B, Brinkert D, Meyer N, Adam P, Bonnomet F, Ehlinger M
Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
GMRC, service de santé publique, CHU de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
Orthop Traumatol Surg Res. 2016 Dec;102(8):1069-1073. doi: 10.1016/j.otsr.2016.06.015. Epub 2016 Sep 1.
Tibiofemoral syndesmosis injuries are common but have not been extensively researched. The primary objective of this study was to evaluate the outcomes after temporary screw fixation with ligament repair of these injuries. The secondary objective was to look for factors that could impact these outcomes. We hypothesised that this double fixation (screw+suture) would lead to good outcomes with minimal secondary opening of the syndesmosis upon screw removal.
This was a retrospective study of 285 patients with a tibiofemoral syndesmosis injury (01/2004-12/2011) who were treated by temporary tricortical or quadricortical screw fixation and ligament repair. The operated leg was unloaded for 6-8 weeks postoperative with the patient wearing a walking cast. The screw was removed in all patients before weight bearing was allowed. At follow-up, the range of motion, return to sports, pain, and functional scores (AOFAS and OMAS) were determined, and a radiological assessment was performed.
One hundred twenty-six patients were reviewed after a mean follow-up of 5.9±5.7years (2.9-10.5). Mean plantarflexion was 95% of the contralateral side and mean dorsiflexion was 93%. Return to sports occurred after a mean of 10weeks; 83% of patients returned to their pre-injury level of participation. Pain on VAS was 0.8/10 on average. The mean AOFAS and OMAS scores were both above 90 points. At the review, 4% of screws had broken. Diastasis was found in 5.6% of cases, osteoarthritis in 6.3% and an osteophyte in 11.1% of cases, but with no clinical repercussions. No risk factors were identified.
Treatment by temporary screw fixation and ligament repair leads to good objective results, confirming our hypothesis. However, there is little published data and no consensus on the fixation method or the need to remove the screw.
IV, retrospective, non-comparative.
胫腓骨联合损伤很常见，但尚未得到广泛研究。本研究的主要目的是评估这些损伤采用临时螺钉固定联合韧带修复后的效果。次要目的是寻找可能影响这些效果的因素。我们假设这种双重固定（螺钉+缝线）将带来良好的效果，并且在取出螺钉后胫腓骨联合的二次开口最小。
这是一项对285例胫腓骨联合损伤患者（2004年1月至2011年12月）的回顾性研究，这些患者接受了临时三皮质或四皮质螺钉固定及韧带修复治疗。术后患侧下肢卸力6至8周，患者佩戴行走支具。所有患者在允许负重前取出螺钉。随访时，测定活动范围、恢复运动情况、疼痛程度及功能评分（美国足踝外科协会评分和骨科足踝学会评分），并进行影像学评估。
平均随访5.9±5.7年（2.9至10.5年）后，对126例患者进行了复查。平均跖屈角度为对侧的95%，平均背屈角度为对侧的93%。平均10周后恢复运动；83%的患者恢复到受伤前的参与水平。视觉模拟评分法（VAS）疼痛平均为0.8/10。美国足踝外科协会评分和骨科足踝学会评分的平均分均高于90分。复查时，4%的螺钉发生断裂。5.6%的病例发现有分离，6.3%的病例有骨关节炎，11.1%的病例有骨赘形成，但均无临床影响。未发现危险因素。
临时螺钉固定联合韧带修复治疗可获得良好的客观效果，证实了我们的假设。然而，关于固定方法或是否需要取出螺钉的 published data 很少，也没有共识。
IV级，回顾性、非对比性研究。
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