Stiene Andrew, Renner Charles E, Chen Tian, Liu Jiayong, Ebraheim Nabil A
Medical Student, University of Toledo, College of Medicine and Life Sciences, Toledo, OH.
Assistant Professor, University of Toledo, Department of Mathematics and Statistics, Toledo, OH.
J Foot Ankle Surg. 2019 Mar;58(2):320-327. doi: 10.1053/j.jfas.2018.08.050. Epub 2019 Jan 3.
The goal of the present work was to perform a systematic review of the literature of the past 10 years regarding dynamic and static fixation of the distal tibiofibular syndesmosis to determine any clinical differences between the 2 procedures. A literature search of the PubMed MEDLINE database was conducted to identify relevant studies related to distal tibiofibular syndesmosis. Studies before January 1, 2007, were excluded to limit the project to the recent literature. Clinical outcomes, device removal rates, time to weightbearing after the initial procedure, and the cost effectiveness of each device were explored. In these 26 studies, 350 patients were treated using a dynamic technique and 845 were treated using a static technique. The weighted American Orthopedic Foot and Ankle Score was 91.70 (standard error [SE] 1.87) for dynamic fixation patients and the weighted average was 86.48 (SE 2.17) for static fixation patients (p = .068). A secondary procedure to remove the fixation device was performed in 7.7% of dynamic fixation patients and in 39.4% of static fixation patients when studies with 100% device removal were excluded (p < .0001). The mean time to weightbearing was 5.96 (SE 0.72) weeks for patients who underwent dynamic fixation and 10.45 (SE 0.99) weeks for those who had static fixation (p = .0002). The cost for dynamic fixation was found to be less than that for static fixation when secondary procedures for device removal were considered. Based on similar clinical functional scores, lower secondary procedure rates, faster time to full weightbearing, and lower costs to patients, dynamic fixation of the distal tibiofibular syndesmosis may be a superior option compared with static fixation.
本研究的目的是对过去10年有关胫腓下联合动态和静态固定的文献进行系统回顾，以确定这两种手术方法之间的任何临床差异。通过检索PubMed MEDLINE数据库来查找与胫腓下联合相关的研究。排除2007年1月1日前的研究，以便将项目局限于近期文献。探讨了临床结果、内固定取出率、初次手术后开始负重的时间以及每种内固定的成本效益。在这26项研究中，350例患者采用动态技术治疗，845例患者采用静态技术治疗。动态固定患者的美国矫形足踝协会加权评分是91.70（标准误[SE]1.87），静态固定患者的加权平均分是86.48（SE 2.17）（p = 0.068）。当排除100%取出内固定装置的研究时，7.7%的动态固定患者和39.4%的静态固定患者进行了取出内固定装置的二次手术（p < 0.0001）。接受动态固定的患者开始负重的平均时间为5.96（SE 0.72）周，接受静态固定的患者为10.45（SE 0.99）周（p = 0.0002）。考虑到取出内固定装置的二次手术时，发现动态固定的成本低于静态固定。基于相似的临床功能评分、较低的二次手术率、更快达到完全负重的时间以及更低的患者成本，与静态固定相比，胫腓下联合的动态固定可能是更好的选择。
