损伤机制影响缝合纽扣联合固定的稳定性。
Injury mechanism affects the stability of suture-button syndesmosis fixation.
机构信息
Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
出版信息
J Orthop Surg Res. 2020 Dec 10;15(1):599. doi: 10.1186/s13018-020-02141-3.
BACKGROUND
Ankle syndesmosis injury is a common condition, and the injury mechanism can be sorted into pure syndesmosis injury, Weber-B, and Weber-C type fractures. This study aims to evaluate the treatment outcomes and stability of suture-button fixation for syndesmosis injury with different injury mechanisms. We hypothesized that injury mechanisms would alter the stability of suture-button fixation.
METHODS
We retrospectively reviewed 63 patients with ankle syndesmosis injury who underwent surgery with TightRope (Arthrex, Naples, FL, USA) from April 2014 to February 2019. The stability of suture-button fixation with TightRope was evaluated by comparing the preoperative, postoperative, and final follow-up measurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), and medial clear space (MCS). A subgroup analysis for each demographic group and injury type including pure syndesmosis injury, Weber-B, and Weber-C type fractures were performed.
RESULTS
Syndesmosis was effectively reduced using TightRope. After the index surgery, the tibiofibular clear space was reduced from 7.73 to 4.04 mm, the tibiofibular overlap was increased from 3.05 to 6.44 mm, and the medial clear space was reduced from 8.12 to 3.54 mm. However, syndesmosis widening was noted at the final follow-up, especially in Weber-C type fractures (TFCS 3.82 to 4.45 mm, p < 0.01 and TFO 6.86 to 6.29 mm, p = 0.04). Though widened, the final follow-up values of tibiofibular clear space and tibiofibular overlap were in the acceptable range. Postoperatively and at the final follow-up, medial clear space was found to be significantly larger in the Weber-C group than in the pure syndesmosis and Weber-B groups (p < 0.05).
CONCLUSIONS
Suture-button fixation can offer anatomic reduction and dynamic fixation in syndesmosis injuries. However, when using this modality for Weber-C type fractures, more attention should be focused on the accuracy of reduction, especially of medial clear space, and rediastasis should be carefully monitored.
TRIAL REGISTRATION
This trial was retrospectively approved by TMU-JIRB. Registration number N202004122, and the date of approval was May 06, 2020.
LEVEL OF EVIDENCE
III.
背景
踝关节联合损伤是一种常见的损伤，其损伤机制可分为单纯联合损伤、Weber-B 型和 Weber-C 型骨折。本研究旨在评估不同损伤机制下使用纽扣缝线固定治疗联合损伤的治疗效果和稳定性。我们假设损伤机制会改变纽扣缝线固定的稳定性。
方法
我们回顾性分析了 2014 年 4 月至 2019 年 2 月期间使用 Arthrex（那不勒斯，佛罗里达州，美国）TightRope 进行手术治疗的 63 例踝关节联合损伤患者。通过比较术前、术后和最终随访时的胫腓骨间隙（TFCS）、胫腓骨重叠（TFO）和内侧间隙（MCS），评估 TightRope 纽扣缝线固定的稳定性。对每个人口统计学组和损伤类型（包括单纯联合损伤、Weber-B 型和 Weber-C 型骨折）进行亚组分析。
结果
TightRope 可有效减少联合损伤。在指数手术后，胫腓骨间隙从 7.73 减少到 4.04mm，胫腓骨重叠从 3.05 增加到 6.44mm，内侧间隙从 8.12 减少到 3.54mm。然而，在最终随访时，联合处增宽，尤其是 Weber-C 型骨折（TFCS 从 3.82 增加到 4.45mm，p < 0.01 和 TFO 从 6.86 增加到 6.29mm，p = 0.04）。尽管增宽，但胫腓骨间隙和胫腓骨重叠的最终随访值仍在可接受范围内。术后和最终随访时，Weber-C 组的内侧间隙明显大于单纯联合损伤和 Weber-B 组（p < 0.05）。
结论
纽扣缝线固定可提供联合损伤的解剖复位和动力固定。然而，对于 Weber-C 型骨折，应更加注意复位的准确性，特别是内侧间隙的复位，并且应仔细监测再分离。
临床试验注册号
本试验经 TMU-JIRB 回顾性批准。注册号 N202004122，批准日期为 2020 年 5 月 6 日。
证据水平
III 级。
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