Professor, Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
Professor, Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea.
J Foot Ankle Surg. 2021 Mar-Apr;60(2):339-344. doi: 10.1053/j.jfas.2020.04.021. Epub 2020 Nov 25.
The treatment of syndesmotic injuries with ankle fractures is controversial. The purpose of this study was to compare the biomechanical properties of open anterior syndesmotic repair with those of screw fixation. Ten matched pairs of human cadaver specimens were subjected to open syndesmotic repair or screw fixation. Each specimen underwent initial intact physiologic loading, consisting of 10 cycles of external torsional loading with a peak torque of 7.5 Nm at 0.05 Hz. Injuries of the anterior inferior tibiofibular ligament, tibiofibular interosseous membrane, and deltoid ligament were applied to each specimen. Postfixation cyclic loading consisted of 50 cycles of combined axial and external rotation loading with peak torques of 750 N and 7.5 Nm at a rate of 0.05 Hz. After postfixation loading, each specimen underwent failure loading by external rotation at 0.25 degrees/second. Failure torque and failure angle were measured. The paired t test and Wilcoxon signed-rank test were used to analyze the data. Mean failure torques were 95.63 Nm in the open anterior syndesmotic repair augmented with suture-tape group and 108.61 Nm in the screw group. Mean failure angles were 34.93 degrees in the open anterior syndesmotic repair augmented with suture-tape group and 43.55 degrees in the screw group. These data were not statistically significantly different between the groups (p= .7682 and .4133, respectively). Open anterior syndesmotic repair augmented with suture tape for ankle syndesmotic injury provides similar torsional strength to that of screw fixation. Therefore, this technique can be considered as an alternative treatment option for syndesmosis injury.
下胫腓联合损伤伴踝关节骨折的治疗存在争议。本研究旨在比较开放式前联合修复与螺钉固定的生物力学特性。10 对配对的人尸体标本分别进行了开放式前联合修复或螺钉固定。每个标本都进行了初始完整的生理负荷，包括 10 个周期的外部扭转加载，峰值扭矩为 0.05Hz 时为 7.5Nm。每个标本都施加了前下胫腓韧带、下胫腓骨间膜和三角韧带的损伤。固定后的循环加载包括 50 个周期的轴向和外部旋转加载，峰值扭矩分别为 750N 和 7.5Nm，频率为 0.05Hz。固定后加载后，每个标本以 0.25 度/秒的速度进行外部旋转失效加载。测量失效扭矩和失效角度。采用配对 t 检验和 Wilcoxon 符号秩检验对数据进行分析。带缝线的开放式前联合修复组的平均失效扭矩为 95.63Nm，螺钉组的平均失效扭矩为 108.61Nm。带缝线的开放式前联合修复组的平均失效角度为 34.93 度，螺钉组的平均失效角度为 43.55 度。两组之间的数据差异无统计学意义（分别为 p=.7682 和.4133）。带缝线的开放式前联合修复治疗踝关节下胫腓联合损伤提供了与螺钉固定相似的扭转强度。因此，这种技术可以被认为是下胫腓联合损伤的一种替代治疗选择。
