螺钉、韧带重建和新型双 Endobutton 在治疗胫腓联合损伤中的生物力学比较。
Biomechanical comparison of screw, tightrope and novel double endobutton in the treatment of tibiofibular syndesmotic injuries.
机构信息
Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China, 646000; Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou,China, 646000; Expert Workstation in Luzhou, Luzhou, Sichuan, China, 646000; Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China, 646000.
School of Clinical Medicine, Southwest Medical University, Luzhou, China, 646000.
出版信息
Injury. 2021 Oct;52(10):2813-2819. doi: 10.1016/j.injury.2021.06.011. Epub 2021 Jun 18.
BACKGROUND
Adequate reduction and stabilization of the syndesmosis are significant to prevent early degeneration of the ankle joint and get better clinical outcomes. However, the routine surgical methods have diffierent limitations. The purpose of this study was to develop a novel double Endobutton fixation to treat the distal tibiofibular syndesmotic injuries, and determine whether the novel double Endobutton fixation demonstrates a better biomechanical property compare with the intact syndesmosis, the screw fixation and the Tightrope fixation.
METHODS
Twenty-four normal fresh-frozen ankle specimens with a mean age of 42 ± 8 (range, 28-62) years were randomly divided equally into four groups: (1) the intact group, (2) the screw group, (3) the Tightrope group, (4) the Endobutton group. 3D printer technology was used to establish the personalized distal tibiofibular syndesmotic navigation modules to determine the accurate bone tunnel. Axial loading was applied in five ankle positions: neutral position, dorsiflexion, plantar flexion, varus and valgus. Rotation torque was applied in two ankle rotation of the neutral position: internal and external.
RESULTS
In most situations, the displacements of the intact group were larger than the screw group, the Tightrope group and the Endobutton group (P < .05), and the displacements of the screw group were smaller than other three groups (P < .05). The displacements of the double Endobutton group were slightly larger than the Tightrope group but no significant differences were found between these two groups except in the dorsiflexion position of axial loading experiments (P < .05). The novel double Endobutton fixation was steadier than intact syndesmosis and more micromotional than screw fixation.
CONCLUSION
Our study demonstrated that the novel double Endobutton can be considered as the better fixation in treatment of distal tibiofibular syndesmotic injuries.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
背景
适当的下胫腓联合复位和固定对于预防踝关节早期退变和获得更好的临床效果非常重要。然而，常规的手术方法存在不同的局限性。本研究旨在开发一种新型双 Endobutton 固定治疗下胫腓联合损伤，并确定新型双 Endobutton 固定与完整的下胫腓联合、螺钉固定和 Tightrope 固定相比是否具有更好的生物力学性能。
方法
24 个平均年龄为 42±8（范围 28-62）岁的正常新鲜冷冻踝关节标本被随机平均分为四组：（1）完整组，（2）螺钉组，（3）Tightrope 组，（4）Endobutton 组。使用 3D 打印机技术建立个性化的下胫腓联合导航模块来确定准确的骨隧道。在五个踝关节位置（中立位、背屈、跖屈、内翻和外翻）施加轴向加载。在中立位的两个踝关节旋转施加旋转扭矩：内旋和外旋。
结果
在大多数情况下，完整组的位移大于螺钉组、Tightrope 组和 Endobutton 组（P<.05），而螺钉组的位移小于其他三组（P<.05）。双 Endobutton 组的位移略大于 Tightrope 组，但除轴向加载实验背屈位外，两组之间无显著差异（P<.05）。新型双 Endobutton 固定比完整的下胫腓联合更稳定，比螺钉固定更微动。
结论
我们的研究表明，新型双 Endobutton 可作为治疗下胫腓联合损伤的更好固定方法。
证据水平
III 级，回顾性比较研究。
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