Department of Orthopedics, Second Affiliated Hospital of Anhui Medical University, Hefei, China.
J Orthop Surg Res. 2023 Apr 3;18(1):269. doi: 10.1186/s13018-023-03579-x.
The distal tibiofibular syndesmosis (DTS) is a complex fibrous joint that contributes to the stability and weight-bearing function of the ankle. As such, repair of DTS injury is required, providing fixation strength while maintaining ankle range of motion. The aim of this study was to compare a new elastic fixation technique, using an encircling and binding technique, for DTS stabilization, compared to the traditional cortical bone screw fixation.
This was a retrospective analysis of 67 patients treated for a DTS injury at our hospital, between June 2019 and June 2021. Of them, 33 were treated with encircling and binding (EB group) and 34 using a cortical screw (CS group). The following outcomes were compared between groups: time to inferior tibiofibular fixation; length of hospital stay; time to partial weight bearing; time to complete weight bearing; complications; imaging data; and functional scores.
Successful stabilization was achieved in all cases, with a mean follow-up period of 15.78 ± 2.97 months. Time to fixation and time to partial and complete weight bearing were shorter for the EB than that for the CS group. The length of hospital was not different between groups. With regard to complications, a superficial infection developed in one patient in each group, with wound healing achieved after active treatment. Screw fracture occurred in two patients in the CS group. At 3 months post-surgery, the American Foot Surgery Association Ankle-Hindfoot score (AOFAS) was higher and the pain score lower for the EB than that for the CS group, but with no between-group difference at the final follow-up. On imaging, the tibiofibular clear space and tibiofibular overlap were not different between groups.
DTS fixation using encircling and binding yielded better clinical and functional outcomes than did cortical screw fixation at 3 months post-surgery, with no difference at the final follow-up. This novel fixation technique provides firm fixation, combined with earlier return to postoperative exercise and recovery of ankle function.
下胫腓联合（DTS）是一个复杂的纤维关节，有助于维持踝关节的稳定性和承重功能。因此，需要修复 DTS 损伤，既要提供固定强度，又要保持踝关节的活动范围。本研究旨在比较一种新的弹性固定技术，即使用环绕和捆绑技术固定 DTS，与传统的皮质骨螺钉固定进行比较。
这是对 2019 年 6 月至 2021 年 6 月期间在我院接受 DTS 损伤治疗的 67 例患者进行的回顾性分析。其中 33 例采用环绕和捆绑（EB 组），34 例采用皮质骨螺钉（CS 组）。比较两组之间的以下结果：下胫腓固定时间；住院时间；部分负重时间；完全负重时间；并发症；影像学数据；和功能评分。
所有病例均实现了稳定的固定，平均随访时间为 15.78±2.97 个月。EB 组的固定时间、部分和完全负重时间均短于 CS 组。两组的住院时间无差异。关于并发症，每组均有 1 例发生浅表感染，经积极治疗后伤口愈合。CS 组有 2 例患者发生螺钉骨折。术后 3 个月，EB 组的美国足外科协会踝关节-后足评分（AOFAS）较高，疼痛评分较低，但最终随访时无组间差异。影像学上，两组的胫腓骨间隙和胫腓骨重叠均无差异。
与皮质骨螺钉固定相比，环绕和捆绑固定在下胫腓联合固定术后 3 个月时可获得更好的临床和功能结果，最终随访时无差异。这种新型固定技术提供了牢固的固定，同时结合了更早的术后运动和踝关节功能恢复。
