腓骨远端旋转不良与外踝接触特征。

Distal fibular malrotation and lateral ankle contact characteristics.

作者信息

Stroh D Alex, DeFontes Kenneth, Paez Adrian, Parks Brent, Guyton Gregory P

机构信息

Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, United States.

出版信息

Foot Ankle Surg. 2019 Feb;25(1):90-93. doi: 10.1016/j.fas.2017.09.001. Epub 2017 Sep 20.

DOI:10.1016/j.fas.2017.09.001

PMID:29409299

Abstract

BACKGROUND

Any amount of malreduction of the syndesmotic joint compared with the uninjured syndesmosis has been associated with an adverse effect on functional outcome. The amount of malrotation that may lead to clinically relevant pressure change in this joint has not been reported. Our purpose was to determine whether small degrees of external and internal malrotation would be associated with statistically significant changes in contact pressure in the tibiofibular and talofibular articulations.

METHODS

Twelve cadaveric ankles were osteotomized above the syndesmosis and instrumented with a rotatable distal fibula plate. Sensors at the distal tibiofibular and talofibular articulations recorded contact pressure and area at neutral position and at 5 and 10° of external and internal malrotation through a full range of ankle motion.

RESULTS

Compared with neutral rotation, there was a significant decrease in contact pressure at the talofibular articulation with external rotation of 5° (103±113kPa versus 52±69kPa; P=0.01) and 10° (43±62kPa; P=0.01) in plantarflexion.Contact pressure at the tibiofibular articulation in plantarflexion increased with 10° of internal malrotation compared with neutral rotation (56±30kPa versus 74±38kPa; P=0.05) in plantarflexion. Contact area decreased significantly with plantarflexion and 10° of external rotation and increased significantly in plantarflexion and after cyclic loading with 10° of internal rotation (P≤0.05).

CONCLUSION

Any degree of distal fibular external rotation significantly reduced contact pressure in the talofibular articulation with plantarflexion. A minimal increase in contact pressure was found in the tibiofibular and talofibular joints with plantarflexion and mild internal rotation of 5°, but pressure increased significantly in both articulations with 10° of internal rotation. The findings support clinical findings that subtle degrees of fibular malrotation may be associated with alteration of lateral ankle mechanics.

LEVEL OF EVIDENCE

Controlled biomechanical study.

摘要

背景

与未受伤的下胫腓联合相比，下胫腓联合的任何程度的复位不良都与功能预后的不良影响相关。尚未报道可能导致该关节出现临床相关压力变化的旋转不良程度。我们的目的是确定小程度的外旋和内旋是否会与胫腓关节和距腓关节的接触压力发生统计学上的显著变化相关。

方法

对12具尸体踝关节在胫腓联合上方进行截骨，并安装可旋转的远端腓骨钢板。通过踝关节的全范围运动，记录胫腓远端关节和距腓关节在中立位以及外旋和内旋5°及10°时的接触压力和面积。

结果

与中立旋转相比，在跖屈时距腓关节处，外旋5°（103±113kPa对52±69kPa；P=0.01）和10°（43±62kPa；P=0.01）时接触压力显著降低。与中立旋转相比，在跖屈时胫腓关节处，内旋10°时接触压力增加（跖屈时56±30kPa对74±38kPa；P=0.05）。接触面积在跖屈和外旋10°时显著减小，在跖屈和内旋循环加载10°后显著增加（P≤0.05）。