Imam Mohamed A, Matthana Ahmed, Kim Ji Wan, Nabil Mohamed
Senior Lecturer and Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Senior Lecturer and Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
J Foot Ankle Surg. 2017 Jul-Aug;56(4):744-747. doi: 10.1053/j.jfas.2017.02.010.
In the present retrospective analysis, we introduce a custom suture-button fixation device for acute ankle syndesmotic injuries that allows for early weightbearing without another planned operation for hardware removal. We evaluated 87 consecutive ankles in 87 patients (49 males [56.32%] and 38 females [43.68%]). Of the 87 patients, 15 (17.24%) withdrew or were lost to follow-up, leaving 72 patients (82.76%) in the present study. Their mean age was 35.2 (range 17 to 67) years. Nineteen patients (26.39%) presented with a pure syndesmotic disruption, and 53 (73.61%) had associated malleolar fractures. The American Orthopaedic Foot and Ankle Society scale score improved significantly from 31.2 ± 4.2 preoperatively to 88.5 ± 5.3 at an average of 24 months postoperatively (p < .0043). Revision was undertaken because of implant failure in 4 ankles (5.56%). Two revisions (2.78%) were performed in 2 ankles because of early weightbearing in the first 2 weeks after surgery. The third patient (1.39%) underwent revision at 5 weeks postoperatively. This syndesmotic reduction failure was attributed to failure of the threads, which was noted at the second surgery. The fourth patient (1.39%), a 66-year-old male, underwent revision at 5 months postoperatively because of persistent infection. An 18-month postoperative radiograph was available for all patients. The medial clear space had significantly decreased, from 8.2 ± 3.1 mm preoperatively to 3.5 ± 2.2 mm at 18 months postoperatively (p < .0344). Likewise, the tibiofibular clear space had decreased significantly, from a mean of 8.8 ± 3.7 mm preoperatively to a mean of 3.7 ± 2.2 mm at 18 months postoperatively (p < .0322). In conclusion, suture-button fixation described in the present report delivered satisfactory functional outcomes and anatomic reduction at minimum of 18 months after surgery.
在本次回顾性分析中，我们介绍了一种用于急性踝关节下胫腓联合损伤的定制缝线纽扣固定装置，该装置可实现早期负重，且无需另行计划手术取出内固定物。我们评估了87例患者的87个连续踝关节（49例男性[56.32%]，38例女性[43.68%]）。87例患者中，15例（17.24%）退出或失访，本研究中剩余72例患者（82.76%）。他们的平均年龄为35.2岁（范围17至67岁）。19例患者（26.39%）表现为单纯下胫腓联合损伤，53例（73.61%）伴有踝关节骨折。美国矫形足踝协会评分从术前的31.2±4.2显著提高至术后平均24个月时的88.5±5.3（p<.0043）。4个踝关节（5.56%）因植入物失败而进行了翻修。2个踝关节（2.78%）在术后前2周因早期负重进行了2次翻修。第3例患者（1.39%）在术后5周进行了翻修。这种下胫腓联合复位失败归因于缝线失败，这在第二次手术时被发现。第4例患者（1.39%），一名66岁男性，因持续感染在术后5个月进行了翻修。所有患者均有术后18个月的X线片。内侧间隙显著减小，从术前的8.2±3.1mm降至术后18个月时的3.5±2.2mm（p<.0344）。同样，胫腓间隙也显著减小，从术前平均8.8±3.7mm降至术后18个月时平均3.7±2.2mm（p<.0322）。总之，本报告中描述的缝线纽扣固定在术后至少18个月时提供了满意的功能结果和解剖复位。
