LaMothe Jeremy, Baxter Josh R, Gilbert Susannah, Murphy Conor I, Karnovsky Sydney C, Drakos Mark C
1 Section of Orthopaedic Surgery, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada.
2 Hospital for Special Surgery, New York, New York, USA.
Foot Ankle Int. 2017 Jun;38(6):694-700. doi: 10.1177/1071100717696360. Epub 2017 Mar 15.
Syndesmotic injuries can be associated with poor patient outcomes and posttraumatic ankle arthritis, particularly in the case of malreduction. However, ankle joint contact mechanics following a syndesmotic injury and reduction remains poorly understood. The purpose of this study was to characterize the effects of a syndesmotic injury and reduction techniques on ankle joint contact mechanics in a biomechanical model.
Ten cadaveric whole lower leg specimens with undisturbed proximal tibiofibular joints were prepared and tested in this study. Contact area, contact force, and peak contact pressure were measured in the ankle joint during simulated standing in the intact, injured, and 3 reduction conditions: screw fixation with a clamp, screw fixation without a clamp (thumb technique), and a suture-button construct. Differences in these ankle contact parameters were detected between conditions using repeated-measures analysis of variance.
Syndesmotic disruption decreased tibial plafond contact area and force. Syndesmotic reduction did not restore ankle loading mechanics to values measured in the intact condition. Reduction with the thumb technique was able to restore significantly more joint contact area and force than the reduction clamp or suture-button construct.
Syndesmotic disruption decreased joint contact area and force. Although the thumb technique performed significantly better than the reduction clamp and suture-button construct, syndesmotic reduction did not restore contact mechanics to intact levels.
Decreased contact area and force with disruption imply that other structures are likely receiving more loads (eg, medial and lateral gutters), which may have clinical implications such as the development of posttraumatic arthritis.
下胫腓联合损伤可能导致患者预后不良及创伤后踝关节炎，尤其是在复位不良的情况下。然而，下胫腓联合损伤及复位后踝关节的接触力学仍知之甚少。本研究的目的是在生物力学模型中描述下胫腓联合损伤及复位技术对踝关节接触力学的影响。
本研究制备并测试了10个尸体完整小腿标本，其胫腓近端关节未受干扰。在完整、损伤及3种复位情况下（使用夹具的螺钉固定、不使用夹具的螺钉固定（拇指技术）和缝线纽扣结构）模拟站立时测量踝关节的接触面积、接触力和峰值接触压力。使用重复测量方差分析检测这些踝关节接触参数在不同情况下的差异。
下胫腓联合损伤减少了胫骨平台的接触面积和力。下胫腓联合复位未能将踝关节负荷力学恢复到完整状态下测量的值。与复位夹具或缝线纽扣结构相比，拇指技术复位能够显著恢复更多的关节接触面积和力。
下胫腓联合损伤减少了关节接触面积和力。尽管拇指技术的表现明显优于复位夹具和缝线纽扣结构，但下胫腓联合复位并未将接触力学恢复到完整水平。
损伤时接触面积和力的减少意味着其他结构可能承受了更多负荷（如内侧和外侧沟），这可能具有临床意义，如创伤后关节炎的发展。
