Che Jian, Li Chunbao, Gao Zhipeng, Qi Wei, Ji Binping, Liu Yujie, Liow Ming Han Lincoln
Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
Department of Orthopedics, Shanxi Huajin Orthopedic Hospital, Taiyuan, 030024, China.
Knee Surg Sports Traumatol Arthrosc. 2017 Jun;25(6):1866-1872. doi: 10.1007/s00167-017-4485-y. Epub 2017 Mar 20.
To date, there is a paucity of literature on syndesmotic reconstruction techniques that restore both anatomic stability and physiologic syndesmotic biomechanics. In this cadaveric study, (1) a novel syndesmotic reconstruction surgical technique using autogenous peroneus brevis tendon was described and (2) the biomechanical properties of the reconstruction was investigated.
Ten fresh-frozen lower extremities were used in this study. Reconstruction of the anterior and posterior, as well as the interosseous tibiofibular ligaments was performed with a halved peroneus brevis tendon. Biomechanics were assessed using foot external rotation torque and ankle dorsiflexion axial loading tests, which were performed in (a) intact, (b) cut, (c) anatomically reconstructed syndesmotic ligaments, and (d) 3.5 mm tricortical syndesmotic screw fixation. Medial-lateral and anterior-posterior displacements of the distal fibula were recorded during foot external rotation and fibular axial displacement was recorded during ankle axial loading.
The fibula was displaced posteriorly and proximally with respect to the tibia in all specimens during external rotation and axial loading tests, respectively. Significant differences (p < 0.05) were found in distal fibular displacements between anatomically reconstructed ligaments and screw fixation. Tricortical syndesmotic screw fixation resulted in 59% of posterior fibular displacement when compared to intact ligaments. No significant differences (n.s.) in distal fibular displacement were demonstrated between intact ligaments and anatomically reconstructed ligaments.
Anatomical reconstruction of the distal tibiofibular ligaments with the peroneus brevis tendon provides stability and recreates the biomechanical properties of an intact syndesmosis. This new surgical technique may be a viable alternative for the treatment of syndesmotic injuries.
V.
迄今为止，关于能恢复解剖稳定性和生理下胫腓联合生物力学的下胫腓联合重建技术的文献较少。在这项尸体研究中，（1）描述了一种使用自体短腓骨肌腱的新型下胫腓联合重建手术技术，（2）研究了该重建的生物力学特性。
本研究使用了10个新鲜冷冻的下肢。用对半劈开的短腓骨肌腱对胫腓前、后韧带以及骨间韧带进行重建。使用足部外旋扭矩和踝关节背屈轴向负荷试验评估生物力学，这些试验在（a）完整、（b）切断、（c）解剖重建的下胫腓联合韧带以及（d）3.5毫米三皮质下胫腓联合螺钉固定的情况下进行。在足部外旋过程中记录腓骨远端的内外侧和前后位移，在踝关节轴向负荷过程中记录腓骨轴向位移。
在所有标本中，分别在外部旋转和轴向负荷试验期间，腓骨相对于胫骨向后和近端移位。在解剖重建韧带和螺钉固定之间，腓骨远端位移存在显著差异（p < 0.05）。与完整韧带相比，三皮质下胫腓联合螺钉固定导致腓骨后移59%。完整韧带和解剖重建韧带之间在腓骨远端位移方面未显示出显著差异（无显著性差异）。
用短腓骨肌腱对胫腓远端韧带进行解剖重建可提供稳定性并重现完整下胫腓联合的生物力学特性。这种新的手术技术可能是治疗下胫腓联合损伤的一种可行替代方法。
V级。
