Jia Zhaofeng, Cheng Jiwu, Zhong Haiyan, Xiao Tinghui, Ren Jinke, Lin Yimiao, Huang Wenjun, Liang Yujie, Liu Qisong, Zhang Xiaoming
Department of Osteoarthropathy, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology Shenzhen 518035, Guangdong Province, China.
Department of Chemistry, The Chinese University of Hong Kong Shatin, Hong Kong SAR, China.
Am J Transl Res. 2019 Aug 15;11(8):4967-4975. eCollection 2019.
Distal tibiofibular syndesmosis injury (DTS) occurs frequently with ankle sprains. Current treatments pose several limitations including causing soft tissue irritation, bringing damage to fixation secondary to weight-bearing, and requiring follow-up surgeries. Here, we investigated the clinical effects of a new technique, titanium cable isotonic annular fixation, for the treatment of DTS injury. From January 2015 to June 2017, 36 patients with ankle fractures and DTS injuries had their fractures repaired with the titanium cable isotonic annular fixation system. Recovery was scored by the AOFAS ankle function score system. We also assessed the differences in ankle motion between healthy and operative joints, and recorded the complications. All patients recovered from surgery without any serious complications. We followed all the cases for 18-25 months with an average follow-up of 21.26±3.23 months. 12 months after the operation, X-ray images showed that the titanium cables were fixed in the correct position without any fracture or loosening. Additionally, no degeneration or traumatic arthritis was observed in the ankle joint. There were no incision or bone mineral density changes between the titanium fix and tibiofibular bones. Nearly all patients recovered well except for three who developed inflammation and infection. However, these three patients recovered following 1 week of intravenous antibiotics and local radiofrequency physiotherapy. According to the AOFAS scoring system, all patients achieved satisfactory recovery 12 months post operation. Our titanium cable isotonic annular fixation system has both the advantages of elastic and rigid fixations. It can restore isotonic strength of the distal tibiofibular joint, and its biomechanical performance approaches normal physiological function. After the operation, patients tolerated weight-bearing exercise and recovered joint mobility. Finally, there is no need to remove the distal tibiofibular implant after 12 weeks. Overall, it is a highly effective surgical method to treat DTS injury.
下胫腓联合损伤（DTS）常与踝关节扭伤同时发生。目前的治疗方法存在一些局限性，包括引起软组织刺激、负重导致内固定损坏以及需要二次手术。在此，我们研究了一种新技术——钛缆等张环形固定术治疗DTS损伤的临床效果。2015年1月至2017年6月，36例踝关节骨折合并DTS损伤患者采用钛缆等张环形固定系统修复骨折。采用美国足踝外科协会（AOFAS）踝关节功能评分系统进行恢复情况评分。我们还评估了健康关节与手术关节之间踝关节活动度的差异，并记录并发症情况。所有患者术后均康复，无严重并发症。所有病例随访18 - 25个月，平均随访21.26±3.23个月。术后12个月，X线片显示钛缆固定位置正确，无骨折或松动。此外，踝关节未见退变或创伤性关节炎。钛固定与胫腓骨之间无切口或骨密度变化。除3例发生炎症和感染外，几乎所有患者恢复良好。然而，这3例患者经1周静脉抗生素治疗和局部射频理疗后康复。根据AOFAS评分系统，所有患者术后12个月均获得满意恢复。我们的钛缆等张环形固定系统兼具弹性固定和刚性固定的优点。它能恢复下胫腓关节的等张强度，其生物力学性能接近正常生理功能。术后患者耐受负重锻炼，关节活动度恢复。最后，术后12周无需取出下胫腓植入物。总体而言，这是一种治疗DTS损伤的高效手术方法。
