Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany.
ZESBO - Centre for Research on Musculoskeletal Systems, University of Leipzig, Semmelweisstraße 14, 04103, Leipzig, Saxony, Germany.
BMC Musculoskelet Disord. 2021 Nov 22;22(1):970. doi: 10.1186/s12891-021-04834-0.
Inadequate reduction of syndesmotic injuries can result in disabling clinical outcomes. The aim of the study was to compare syndesmosis congruity after fixation by syndesmotic screws (SYS) or a suture button system (SBS) using three-dimensional (3D) computed imaging techniques.
In a retrospective single-center study, patients with unilateral stabilization of an ankle fracture with a syndesmotic injury and post-operative bilateral CT scans were analyzed using a recently established 3D method. The side-to-side differences were compared for tibio-fibular clear space (∆CS), translation angle (∆α), and vertical offset (∆z) among patients stabilized with syndesmotic screws or suture button system. Syndesmotic malreduction was defined for ∆CS > 2 mm and for |∆α| > 5°. ∆CS and ∆α were correlated with two-dimensional (2D) measurements.
Eighteen patients stabilized with a syndesmosis screw and 29 stabilized with a suture button system were analyzed. After stabilization, both groups revealed mild diastasis (SYS: mean ∆CS 0.3 mm, SD 1.1 mm vs SBS: mean ∆CS 0.2 mm, SD 1.2 mm, p = 0.710). In addition, both stabilization methods showed slight dorsalization of the fibula (SYS: mean ∆α 0.5°, SD 4.6° vs SBS: mean ∆α 2.1°, SD 3.7°, p = 0.192). Also, restoration of the fibula-to-tibia length ratio also did not differ between the two groups (SYS: mean Δz of 0.5 mm, SD 2.4 mm vs SBS: mean Δz of 0 mm, SD 1.2 mm; p = 0.477). Malreduction according to high ∆α was most common (26% of cases), with equal distribution between the groups (p = 0.234). ∆CS and ∆α showed good correlation with 2D measurements (ρ = 0.567; ρ = 0.671).
This in vivo analysis of post-operative 3D models showed no differences in immediate post-operative alignment after syndesmotic screws or suture button system. Special attention should be paid to syndesmotic malreduction in the sagittal orientation of the fibula in relation to the tibia in radiological control of the syndesmotic congruity as well as intra-operatively.
下胫腓联合损伤如果复位不充分，可能会导致严重的临床后果。本研究旨在比较使用三维（3D）计算机成像技术固定后胫腓联合的复位情况，比较使用胫腓联合螺钉（SYS）或缝线纽扣系统（SBS）固定的效果。
这是一项回顾性单中心研究，分析了单侧踝关节骨折合并下胫腓联合损伤患者术后双侧 CT 扫描的资料，使用了一种新建立的 3D 方法。比较 SYS 或 SBS 固定后患者的胫腓骨间隙差值（∆CS）、平移角度（∆α）和垂直偏移（∆z）。将 ∆CS > 2mm 和 |∆α| > 5°定义为下胫腓联合复位不良。∆CS 和 ∆α 与二维（2D）测量值相关。
18 例患者采用 SYS 固定，29 例患者采用 SBS 固定。固定后两组均有轻度分离（SYS：平均 ∆CS 0.3mm，SD 1.1mm 比 SBS：平均 ∆CS 0.2mm，SD 1.2mm，p=0.710）。此外，两种固定方法均显示腓骨轻度背侧移位（SYS：平均 ∆α 0.5°，SD 4.6°比 SBS：平均 ∆α 2.1°，SD 3.7°，p=0.192）。两组腓骨-胫骨长度比的恢复也无差异（SYS：平均 ∆z 为 0.5mm，SD 2.4mm 比 SBS：平均 ∆z 为 0mm，SD 1.2mm，p=0.477）。根据高 ∆α 值确定的复位不良最为常见（26%的病例），两组分布相同（p=0.234）。∆CS 和 ∆α 与 2D 测量值具有良好的相关性（ρ=0.567；ρ=0.671）。
本研究对术后 3D 模型进行了活体分析，结果显示使用胫腓联合螺钉或缝线纽扣系统固定后，下胫腓联合的即刻对线没有差异。在对下胫腓联合复位情况进行影像学检查时，特别是在术中，应特别注意腓骨在矢状面上相对于胫骨的复位不良。
