下胫腓联合损伤后下胫腓联合复位对临床结果的重要性。

Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries.

机构信息

Department of Orthopaedic Surgery, Baerum Hospital, Vestre Viken Hospital Trust, Baerum, Norway.

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

出版信息

J Orthop Trauma. 2019 Aug;33(8):397-403. doi: 10.1097/BOT.0000000000001485.

DOI:10.1097/BOT.0000000000001485

PMID:30973504

Abstract

OBJECTIVES

To evaluate the relationship between syndesmosis reduction and outcome.

DESIGN

Retrospective cohort study.

SETTING

One Level 1 and 1 Level 3 Trauma Center.

PATIENTS

Ninety-seven patients with syndesmosis injury.

INTERVENTION

Stabilization of syndesmosis injury. Open reduction and internal fixation of malleolar fracture, if present.

MAIN OUTCOME MEASUREMENTS

Anterior, central, and posterior measures of syndesmosis width on computed tomography scans, Olerud-Molander Ankle score, American Orthopaedic Foot and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, and range of motion measurements.

RESULTS

Eighty-seven patients completed 2 years of follow-up. The difference in anterior tibiofibular distance (aTFD) between the injured and noninjured ankle postoperatively had a significant effect on the Olerud-Molander Ankle score after 6 weeks [b = -2.6, 95% confidence interval (CI), -4.8 to -0.4; P = 0.02], 1 year (b = -2.7, 95% CI, -4.7 to -0.8; P < 0.001), and 2 years (b = -2.6, 95% CI, -4.6 to -0.6; P = 0.009) and on American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score after 6 weeks (b = -2.2, 95% CI, -3.7 to -0.7; P = 0.004), 1 year (b = -1.7, 95% CI, -3.0 to -0.4; P = 0.04), and 2 years (b = -1.9, 95% CI, -3.2 to -0.5; P = 0.006). The effect of computed tomography measurements on range of motion was inconsistent. Receiver operating characteristic (ROC) curves demonstrated that aTFD had adequate discriminatory performance (area under the ROC curve ≥ 0.7) 1 and 2 years after surgery and the central measurement at only 2 years after surgery. ROC analyses indicate a cutoff value for syndesmosis malreduction of 2 mm. The postoperative rate of malreduction was 32%.

CONCLUSIONS

The aTFD correlated with clinical outcome. A 2-mm difference in aTFD seems to predict poorer clinical outcome.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

评估下胫腓联合复位与结局的关系。

设计

回顾性队列研究。

地点

1 个 1 级和 1 个 3 级创伤中心。

患者

97 例下胫腓联合损伤患者。

干预

下胫腓联合损伤固定。切开复位内固定踝部骨折（如果存在）。

主要观察指标

CT 扫描的下胫腓联合前、中、后宽度测量值，Olerud-Molander 踝关节评分，美国矫形足踝协会踝关节-后足评分，以及活动范围测量值。

结果

87 例患者完成 2 年随访。术后受伤侧与未受伤侧的前胫腓间距（aTFD）差异对术后 6 周（b =-2.6，95%置信区间[CI]，-4.8 至-0.4；P =0.02）、1 年（b =-2.7，95% CI，-4.7 至-0.8；P < 0.001）和 2 年（b =-2.6，95% CI，-4.6 至-0.6；P =0.009）的 Olerud-Molander 踝关节评分有显著影响，术后 6 周（b =-2.2，95% CI，-3.7 至-0.7；P =0.004）、1 年（b =-1.7，95% CI，-3.0 至-0.4；P =0.04）和 2 年（b =-1.9，95% CI，-3.2 至-0.5；P =0.006）的美国矫形足踝协会踝关节-后足评分也有显著影响。CT 测量值对活动范围的影响不一致。受试者工作特征（ROC）曲线显示，aTFD 在术后 1 年和 2 年具有足够的判别性能（ROC 曲线下面积≥0.7），而在术后 2 年仅中央测量值具有足够的判别性能。ROC 分析表明，下胫腓联合复位不良的截断值为 2mm。术后复位不良率为 32%。