去除经皮螺钉固定后胫腓下关节的影像学改变

Radiographic Change of the Distal Tibiofibular Joint Following Removal of Transfixing Screw Fixation.

作者信息

Baek Jong Hun, Kim Tae Yong, Kwon Yoo Beom, Jeong Bi O

机构信息

1 Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

出版信息

Foot Ankle Int. 2018 Mar;39(3):318-325. doi: 10.1177/1071100717745526. Epub 2017 Dec 26.

DOI:10.1177/1071100717745526

PMID:29278930

Abstract

BACKGROUND

Syndesmosis disruptions in the ankle joint are typically treated with anatomic reduction followed by transfixing screw and/or suture button fixation. The purpose of our study was to analyze the effects of the removal of transfixing screws on syndesmosis integrity using plain radiographs and computed tomography (CT) scans.

METHODS

Twenty-nine cases (29 patients) who had been treated with transfixing screw fixation for syndesmosis disruptions were studied prospectively. Plain radiographs and CT scans were obtained 1 day before and 3 months after the removal of transfixing screws. The tibiofibular clear space (TCS) and tibiofibular overlap (TFO) were measured on plain radiographs, and the anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT scans to radiographically analyze the effect of the removal of screws on syndesmosis integrity.

RESULTS

On plain radiographs, syndesmosis diastasis was not observed before or after the removal of transfixing screws. No statistically significant difference was found in the TCS and the TFO between measurements at prescrew removal and at postscrew removal ( P = .761 and .628, respectively). However, the syndesmosis was found malreduced on CT scans in 7 cases (24.1%) before screw removal. All 7 cases showed anterior malreduction of the syndesmosis, 5 (71.4%) of which spontaneously reduced after screw removal. The A/P ratio of the 7 cases decreased from a mean of 1.37 (range, 1.26-1.61) at prescrew removal to a mean of 1.12 (range, 0.96-1.25) at postscrew removal ( P = .016).

CONCLUSION

Syndesmosis malreduction not observed on plain radiographs after performing transfixing screw fixation was identified with CT scans. Of the cases with a malreduced syndesmosis, 71.4% showed spontaneous reduction after screw removal. Therefore, we believe the removal of transfixing screws is recommended after confirming malreduction on CT scans, although plain radiographs demonstrate anatomic reduction.

LEVEL OF EVIDENCE

Level II, prospective prognostic study.

摘要

背景

踝关节下胫腓联合损伤通常采用解剖复位，随后用固定螺钉和/或缝线纽扣进行固定。本研究的目的是使用X线平片和计算机断层扫描（CT）分析取出固定螺钉对下胫腓联合完整性的影响。

方法

前瞻性研究29例（29名患者）接受下胫腓联合损伤固定螺钉固定治疗的病例。在取出固定螺钉前1天和取出后3个月获取X线平片和CT扫描。在X线平片上测量胫腓间隙（TCS）和胫腓重叠（TFO），并在轴向CT扫描上测量下胫腓联合的前后测量比值（A/P比值），以通过影像学分析取出螺钉对下胫腓联合完整性的影响。

结果

在X线平片上，取出固定螺钉前后均未观察到下胫腓联合分离。取出螺钉前和取出螺钉后的测量中，TCS和TFO无统计学显著差异（P分别为0.761和0.628）。然而，在取出螺钉前，CT扫描发现7例（24.1%）下胫腓联合复位不良。所有7例均显示下胫腓联合前侧复位不良，其中5例（71.4%）在取出螺钉后自发复位。这7例的A/P比值从取出螺钉前的平均1.37（范围1.26 - 1.61）降至取出螺钉后的平均1.12（范围0.96 - 1.25）（P = 0.016）。