Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China.
Orthop Surg. 2022 Dec;14(12):3251-3260. doi: 10.1111/os.13508. Epub 2022 Oct 20.
No consensus has been reached regarding optimal implantation for a syndesmotic screw. Thus, we aimed to explore the feasibility of a reliable and static fibular incisura plane reference for ideal syndesmotic screw placement.
A retrospective review of computed tomography (CT) scans of 42 uninjured adult ankles with foot fractures were analyzed to measure the tibiofibular vertical distance (TFVD) at 2.5 cm proximal to the plafond from August 2016 to June 2017 in our hospital. The patients (20 females, 22 males) were divided into four groups according to their TFVD: 0-1, 1-2, 2-3, and 3-4 mm, and patients in each group were counted. We retrospectively assessed 41 patients (15 females, 26 males) who underwent syndesmotic screw fixation for ankle fractures from December 2015 to June 2020. We performed t-testing of two independent samples to determine the differences in the angle between the anatomic axis of the syndesmosis and screw axis (AAS) and ankle function using the American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 6 months postoperatively between the conventional (20 patients) and K-wire marker (21 patients) groups. The correlation between the AAS and AOFAS score was analyzed.
The TFVD measured 2.23 ± 1.01 mm at 2.5 cm proximal to the plafond, and occurred at 25% of the distance from 2 to 3 mm in 47.6% of the patients. This new technique decreased AAS deformation by 62%, from 13.01° ± 2.84° to 4.89° ± 2.43°, in the conventional group (p < 0.001). At 3 months postoperatively, the AOFAS scores of ankle function were similar in both groups, but it was significantly better in the new group than that of conventional group at the 6-month follow-up (p = 0.024). There was a moderate negative correlation between AAS and AOFAS score at 6 months postoperatively (R = -0.684). No obvious complications affecting ankle function were observed in either group postoperatively.
Surgeons can accurately place a screw trajectory using the fibular incisura plane as a reliable intraoperative reference. A 1.6-mm K-wire placed in the syndesmosis at 2.5 cm proximal to the tibial plafond could act as a static marker of the syndesmotic plane.
对于下胫腓联合螺钉的最佳植入方法，尚未达成共识。因此，我们旨在探讨一种可靠的、静态的腓骨切迹平面参考方法，以实现理想的下胫腓联合螺钉固定。
回顾性分析我院 2016 年 8 月至 2017 年 6 月间 42 例足部骨折的 CT 扫描，测量距距骨穹窿 2.5cm 处胫腓骨垂直距离（TFVD）。患者（女性 20 例，男性 22 例）按 TFVD 分为 4 组：0-1mm、1-2mm、2-3mm 和 3-4mm，每组患者的数量进行计数。回顾性分析我院 2015 年 12 月至 2020 年 6 月收治的 41 例（女性 15 例，男性 26 例）接受下胫腓联合螺钉固定的踝关节骨折患者。使用美国矫形足踝协会（AOFAS）评分，对术后 3 个月和 6 个月时常规组（20 例）和 K 线标记组（21 例）的解剖联合轴与螺钉轴之间的角度（AAS）和踝关节功能的差异进行两独立样本 t 检验。分析 AAS 与 AOFAS 评分之间的相关性。
距距骨穹窿 2.5cm 处的 TFVD 为 2.23±1.01mm，在 2-3mm 距离的 47.6%处为 25%。与传统组（13.01°±2.84°）相比，新方法使 AAS 变形减少了 62%（4.89°±2.43°）（p<0.001）。术后 3 个月，两组踝关节功能 AOFAS 评分相似，但术后 6 个月新组明显优于传统组（p=0.024）。术后 6 个月 AAS 与 AOFAS 评分呈中度负相关（R=-0.684）。两组术后均未出现明显影响踝关节功能的并发症。
外科医生可以使用腓骨切迹平面作为可靠的术中参考，准确地放置螺钉轨迹。距骨穹窿 2.5cm 处胫骨平台近端放置 1.6mm 的 K 线可作为下胫腓联合平面的静态标记。
