Department for Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
Department for Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4355-4363. doi: 10.1007/s00402-024-05535-8. Epub 2024 Sep 11.
Acute syndesmosis tears can be treated by static screw or dynamic fixation. Various studies have compared these techniques regarding postoperative outcome. However, to our knowledge, no study has used 3D-instrumented gait analysis (IGA). We hypothesized that a dynamic fixation would perform non-inferior to screw fixation in terms of biomechanical and clinical outcomes.
Patients were prospectively randomized to both groups. All patients received the same follow-up rehabilitation and consultations (6 and 12 weeks; 6 and 12 months) postoperatively. Standardized questionnaires were used to objectify pain and ankle function. At 6 months follow-up, IGA was conducted additionally to objectify the biomechanical outcome.
Twenty-five patients in the dynamic fixation (DF) group using TightRope® and twenty-five in the screw fixation group (SF) completed gait analysis. The DF group showed significantly higher mean values for maximum moment in the affected ankle joint (DF: 1.40 ± 0.21 Nm, SF: 1.23 ± 0.30 Nm; p = 0.023) and the unaffected ankle joint (DF: 1.52 ± 0.20 Nm, SF: 1.37 ± 0.27 Nm; p = 0.035). The difference between the affected and unaffected ankle joint was significantly higher in the SF group for active plantarflexion (DF: 1.52 ± 0.20°, SF: 1.37 ± 0.27°; p = 0.035). Both dynamic and screw fixation groups exhibited significantly reduced plantarflexion during the push-off and early swing phase, with moments and powers in the ankle joint also significantly impaired.
Our study demonstrated that dynamic fixation has better or similar biomechanical and clinical outcomes compared to screw fixation. Future research should focus on biomechanical differences during gait as well as clinical outcomes in case of earlier weight-bearing after dynamic fixation.
TRIAL REGISTRATION NUMBER (TRN): DRKS00013562 Date of Registration: 07/12/2017.
急性下胫腓联合损伤可通过静态螺钉或动态固定进行治疗。各种研究已经比较了这些技术在术后结果方面的差异。然而，据我们所知，没有研究使用过三维仪器步态分析（IGA）。我们假设，在生物力学和临床结果方面，动态固定不会劣于螺钉固定。
前瞻性随机将患者分为两组。所有患者在术后接受相同的随访康复和咨询（6 周和 12 周；6 个月和 12 个月）。使用标准化问卷客观地评估疼痛和踝关节功能。在 6 个月的随访中，还进行了 IGA 以客观评估生物力学结果。
25 例使用 TightRope®的动态固定（DF）组患者和 25 例螺钉固定（SF）组患者完成了步态分析。DF 组的患侧踝关节（DF：1.40±0.21 Nm，SF：1.23±0.30 Nm；p=0.023）和健侧踝关节（DF：1.52±0.20 Nm，SF：1.37±0.27 Nm；p=0.035）的最大力矩平均值显著更高。SF 组在主动跖屈时患侧踝关节与健侧踝关节之间的差值明显更高（DF：1.52±0.20°，SF：1.37±0.27°；p=0.035）。DF 组和 SF 组在蹬离和早期摆动阶段的跖屈均显著减少，踝关节的力矩和功率也显著受损。
我们的研究表明，与螺钉固定相比，动态固定具有更好或相似的生物力学和临床结果。未来的研究应重点关注步态中的生物力学差异，以及动态固定后更早负重时的临床结果。
注册号（TRN）：DRKS00013562 注册日期：2017 年 7 月 12 日。
