Zhang Lei, Li Minghui, Zhang Mengyao, Xiong Jixiang, Wang Junqiu, Zhou Xin, Shi Houyin, Wang Guoyou
Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000, P. R. China.
Center for Orthopedic Diseases Research, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Dec 15;38(12):1480-1485. doi: 10.7507/1002-1892.202406079.
To investigate ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury by using a biomechanical test.
A total of 24 ankle specimens from adult cadavers were used as the tibiofibular syndesmosis injury model. According to the angle of screw placement, the tibiofibular syndesmosis injury models were randomly divided into groups A (0°), B (10°-15°), C (20°-25°), and D (30°-35°), and the screws were placed at a level 2 cm proximal to the ankle joint. The displacement of fibula was measured by biomechanical testing machine at neutral, dorsiflexion (10°), plantar flexion (15°), varus (10°), and valgus (15°) positions, with axial load of 0-700 N (pressure separation test). The displacement of fibula was also measured at neutral position by applying 0-5 N·m torque load during internal and external rotation (torsional separation test).
In the pressure separation test, group C exhibited the smallest displacement under different positions and load conditions. At neutral position, significant differences were observed ( <0.05) between group A and group C under load of 300-700 N, as well as between group B and group C under all load conditions. At dorsiflexion position, significant differences were observed ( <0.05) between group A and group C under load of 500-700 N, as well as between groups B, D and group C under all load conditions, and the displacements under all load conditions were significantly smaller in group A than in group B ( <0.05). At plantar flexion position, significant differences were observed ( <0.05) between group D and group C under all load conditions. At valgus position, significant differences were observed ( <0.05) between group A and group C under load of 400-700 N, as well as between groups B, D and group C under all load conditions. In the torsional separation test, group C exhibited the smallest displacement and group B had the largest displacement under different load conditions. During internal rotation, significant differences were observed ( <0.05) between group B and group C under all load conditions, as well as between group D and group C at load of 3-5 N·m. During external rotation, significant differences were observed between groups B, D and group C under all load conditions ( <0.05). No significant difference was detected between groups at the remaining load conditions ( >0.05).
The ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury was 20°-25°, which has a small displacement of fibula.
通过生物力学试验研究胫腓下联合损伤重建中理想的螺钉植入角度。
取24例成年尸体踝关节标本作为胫腓下联合损伤模型。根据螺钉置入角度，将胫腓下联合损伤模型随机分为A组（0°）、B组（10° - 15°）、C组（20° - 25°）和D组（30° - 35°），在踝关节近端2 cm处置入螺钉。通过生物力学试验机在中立位、背屈（10°）、跖屈（15°）、内翻（10°）和外翻（15°）位测量腓骨移位情况，轴向载荷为0 - 700 N（压力分离试验）。在内旋和外旋时施加0 - 5 N·m扭矩载荷，在中立位测量腓骨移位情况（扭转分离试验）。
在压力分离试验中，C组在不同位置和载荷条件下腓骨移位最小。在中立位，300 - 700 N载荷下A组与C组之间以及所有载荷条件下B组与C组之间均观察到显著差异（<0.05）。在背屈位，500 - 700 N载荷下A组与C组之间以及所有载荷条件下B组、D组与C组之间均观察到显著差异（<0.05），且所有载荷条件下A组的移位均显著小于B组（<0.05）。在跖屈位，所有载荷条件下D组与C组之间均观察到显著差异（<0.05）。在外翻位，400 - 700 N载荷下A组与C组之间以及所有载荷条件下B组、D组与C组之间均观察到显著差异（<0.05）。在扭转分离试验中，C组在不同载荷条件下移位最小，B组移位最大。在内旋时，所有载荷条件下B组与C组之间以及3 - 5 N·m载荷下D组与C组之间均观察到显著差异（<0.05）。在外旋时，所有载荷条件下B组、D组与C组之间均观察到显著差异（<0.05）。在其余载荷条件下各组间未检测到显著差异（>0.05）。
胫腓下联合损伤重建中理想的螺钉植入角度为20° - 25°，此时腓骨移位较小。
