Department of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada.
Department of Orthopaedics, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
Foot Ankle Int. 2021 Jul;42(7):877-885. doi: 10.1177/1071100721990008. Epub 2021 Feb 9.
The goal of the study was to compare radiographic and functional outcomes between conventional closed syndesmotic reduction and screw fixation with open reduction, direct repair of the anterior inferior tibiofibular ligament (AiTFL) and screw fixation. We hypothesized that open reduction with restoration of the AiTFL would provide an improved reduction with better radiographic and functional outcomes.
Fifty consecutive patients with OTA 44-C ankle fractures were enrolled. Treatment was nonrandomized and based on surgeon preference. Patients were treated with either open reduction, suture-anchor AiTFL repair, and screw fixation (ART group), or conventional closed reduction of the syndesmosis followed by screw fixation (CR group). The primary outcome measure was anteroposterior (AP) displacement of the fibula on CT scan at 3 months postoperatively. Secondary outcome measures included the Maryland Foot Score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot and Ankle Outcome Score (FAOS).
Mean AP difference between injured and noninjured ankles was decreased in the ART group compared with the CR group (0.7 ± 0.3 mm vs 1.5 ± 0.3 mm, = .008). No differences were observed between groups in overall scores for secondary outcome measures. The ART group displayed a significant difference in Maryland Foot Shoe subscore at 12 months (ART = 9.5 vs CR = 8.3, = .03) and FAOS Quality of Life subscore at 12 months (64.1 compared to 38.3, = .04).
Open anatomic syndesmotic repair resulted in improved radiographic outcomes compared with closed reduction. Cosmesis was worse at 6 weeks compared to the CR group; however, quality of life and shoewear were improved in the ART group at 1 year postoperatively.
Level II, prospective comparative study.
本研究旨在比较传统闭合下胫腓联合复位固定与切开复位、下胫腓前韧带（AiTFL）直接修复和螺钉固定的影像学和功能结果。我们假设切开复位并修复 AiTFL 可提供更好的复位效果，并改善影像学和功能结果。
连续纳入 50 例 OTA 44-C 踝关节骨折患者。治疗方法是非随机的，基于外科医生的偏好。患者接受切开复位、缝合锚钉 AiTFL 修复和螺钉固定（ART 组）或传统闭合下胫腓联合复位固定（CR 组）。主要结局测量指标为术后 3 个月 CT 扫描时腓骨的前后（AP）移位。次要结局测量指标包括马里兰足部评分、美国矫形足踝协会（AOFAS）踝关节后足评分和足部和踝关节结局评分（FAOS）。
与 CR 组相比，ART 组的受伤和未受伤踝关节之间的 AP 差异减小（0.7±0.3mm 比 1.5±0.3mm，P=.008）。两组间次要结局测量指标的总体评分无差异。ART 组在 12 个月时的马里兰足部鞋类子评分（ART=9.5 比 CR=8.3，P=.03）和 FAOS 生活质量子评分（64.1 比 38.3，P=.04）有显著差异。
与闭合复位相比，切开解剖下胫腓联合复位可获得更好的影像学结果。与 CR 组相比，6 周时的美容效果更差；然而，ART 组在术后 1 年时的生活质量和穿鞋情况得到了改善。
II 级，前瞻性比较研究。
