MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen At Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany.
Eur J Trauma Emerg Surg. 2021 Aug;47(4):897-903. doi: 10.1007/s00068-020-01299-z. Epub 2020 Feb 25.
Acute unstable syndesmotic lesions are regularly treated with closed or open reduction and fixation with either a positioning screw or tight rope. Conventional fluoroscopy is limited to identify a malreduction of the ankle mortise. The aim of the study was to validate the reduction criteria of intraoperative cone beam CT in unstable syndesmotic injuries by analyzing the clinical outcome.
Acute unstable syndesmotic injuries were treated with a positioning screw fixation, and the reduction in the ankle mortise was evaluated with intraoperative cone beam CT. The patients were grouped postoperatively according to the radiological reduction criteria in the intraoperative 3D images. The reduction criteria were unknown to the surgeons. Malreduction was assumed if one or more reduction criteria were not fulfilled.
Seventy-three of the 127 patients could be included in the study (follow-up rate 57.5%). For 41 patients (56.2%), a radiological optimal reduction was achieved (Group 1), and in 32 patients (43.8%) a radiological adverse reduction was found (Group 2). Group 1 scored significantly higher in the Olerud/Molander score (92.44 ± 10.73 vs. 65.47 ± 28.77) (p = 0.003), revealed a significantly higher range of motion (ROM) (53.44 vs. 24.17°) (p = 0.001) and a significantly reduced Kellgren/Lawrence osteoarthritis score (1.24 vs. 1.79) (p = 0.029). The linear regression analysis revealed a correlation for the two groups with the values scored in the Olerud/Molander score (p < 0.01).
The reduction criteria in intraoperative cone beam CT applied to unstable syndesmotic injuries could be validated. Patients with an anatomic reduced acute unstable syndesmotic injury according to the criteria have a significantly better clinical outcome.
急性不稳定的下胫腓联合损伤通常采用闭合或切开复位，使用定位螺钉或张力带固定。传统的 X 光透视仅限于确定踝关节关节面的复位不良。本研究的目的是通过分析临床结果来验证术中锥形束 CT 在不稳定的下胫腓联合损伤中的复位标准。
采用定位螺钉固定治疗急性不稳定的下胫腓联合损伤，并通过术中锥形束 CT 评估踝关节关节面的复位情况。根据术中 3D 图像的影像学复位标准，对术后患者进行分组。手术医生并不知道影像学的复位标准。如果有一个或多个复位标准未满足，则认为存在复位不良。
127 例患者中有 73 例（随访率 57.5%）可纳入研究。41 例（56.2%）患者达到了影像学的最佳复位（第 1 组），32 例（43.8%）患者存在影像学的不良复位（第 2 组）。第 1 组的 Olerud/Molander 评分明显更高（92.44 ± 10.73 比 65.47 ± 28.77）（p = 0.003），运动范围（ROM）明显更大（53.44 比 24.17°）（p = 0.001），Kellgren/Lawrence 骨关节炎评分明显更低（1.24 比 1.79）（p = 0.029）。线性回归分析显示两组与 Olerud/Molander 评分的相关性（p<0.01）。
术中锥形束 CT 应用于不稳定的下胫腓联合损伤的复位标准是可以验证的。根据标准进行解剖复位的急性不稳定的下胫腓联合损伤患者具有显著更好的临床结果。
