Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, South- 1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
BMC Musculoskelet Disord. 2022 Mar 18;23(1):261. doi: 10.1186/s12891-022-05221-z.
Ultrasound examinations for syndesmosis injury might be useful for the quantitative evaluation of syndesmotic instability. The purpose of this study was to evaluate the efficacy of ultrasound assessment by measuring the tibiofibular distance of syndesmosis injuries in various ligament-injured models and stress load conditions.
Five normal ankles from Thiel-embalmed cadavers were used. Ultrasound assessment was performed by placing a probe in parallel with the ligament running just above the anterior inferior tibiofibular ligament (AITFL). The distance between the anterior border of the tibia and the fibula was measured in the intact condition. Next, Bassett's ligament was cut arthroscopically to reduce damage to soft tissues as much as possible and measurement was performed in the same way. After that, the AITFL, interosseous membrane (IOM), deltoid ligament, and posterior inferior tibiofibular ligament (PITFL) were macroscopically cut and measured in that order. Ankle positions were without stress (natural plantar flexion without applying stress to the ankle joint), dorsiflexion stress, inversion stress, and external rotation stress. All stress to the ankle joint was carried out manually to the maximum extent.
As with the without-stress condition, significant increases in tibiofibular distances after AITFL dissection were seen compared with the intact state under all stress conditions (intact: 4.9 ± 1.0 mm without stress, 5.6 ± 1.2 mm with dorsiflexion, 5.9 ± 1.0 mm with inversion, and 6.7 ± 1.3 mm with external rotation; AITFL dissection: 6.7 ± 1.5 mm without stress, 7.3 ± 1.2 mm with dorsiflexion, 7.5 ± 1.4 mm with inversion, and 8.7 ± 1.6 mm with external rotation). AITFL dissection with external rotation stress significantly increased the tibiofibular distance compared to without stress.
Changes in tibiofibular distance with the severity of syndesmosis injury were measured by ultrasound using cadavers. No significant change was seen with Bassett's ligament injury, but tibiofibular distance increased significantly with injuries of equal to or greater severity than AITFL injury. Results were similar not only for external rotation stress, but also for dorsiflexion stress and inversion stress, and even in unloaded states, significant tibiofibular widening was confirmed with injuries of equal to or greater severity than AITFL injury.
超声检查对于下胫腓联合损伤可能有助于对下胫腓联合不稳定进行定量评估。本研究的目的是通过测量下胫腓联合损伤在各种韧带损伤模型和压力负荷条件下的胫腓骨间距来评估超声评估的效果。
使用来自经 Thiel 防腐处理的尸体的五个正常踝关节。通过将探头与刚好位于前下胫腓韧带（AITFL）上方的韧带平行放置来进行超声评估。在完整状态下测量胫骨前边缘和腓骨之间的距离。接下来，通过关节镜切开 Bassett 韧带，以尽可能减少对软组织的损伤，并以同样的方式进行测量。然后，依次切开 AITFL、骨间膜（IOM）、三角韧带和后下胫腓韧带（PITFL）并进行测量。踝关节位置为无应力（无应力的自然跖屈，不对踝关节施加应力）、背屈应力、内翻应力和外旋应力。所有对踝关节的应力均手动施加至最大限度。
与无应力状态一样，在所有应力条件下，AITFL 切开后胫腓骨间距明显增加，与完整状态相比（完整状态：无应力时为 4.9±1.0mm，背屈时为 5.6±1.2mm，内翻时为 5.9±1.0mm，外旋时为 6.7±1.3mm；AITFL 切开时：无应力时为 6.7±1.5mm，背屈时为 7.3±1.2mm，内翻时为 7.5±1.4mm，外旋时为 8.7±1.6mm）。与无应力相比，AITFL 切开伴外旋应力时胫腓骨间距明显增加。
使用尸体通过超声测量下胫腓联合损伤严重程度变化的胫腓骨间距。Bassett 韧带损伤时无明显变化，但 AITFL 损伤同等或更严重的损伤时胫腓骨间距明显增加。结果不仅在外旋应力时相似，在背屈应力和内翻应力时也相似，甚至在无负荷状态下，确认了 AITFL 损伤同等或更严重的损伤时胫腓骨明显增宽。
