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缝线纽扣技术联合下胫腓联合修复与螺钉固定技术治疗完全性下胫腓联合损伤的比较：生物力学尸体研究

Comparison between Suture-Button Technique with Syndesmotic Repair and Screw Fixation Technique for Complete Ankle Syndesmotic Injury: Biomechanical Cadaveric Study.

作者信息

Lee Hong Seop, Kim Sung Hwan, Young Ki Won, Kim Woo Jong, Cheon Dong-Il, Won Sung Hun, Lee Sang Heon, Choi Seung Jin, Lee Young Koo

机构信息

Orthopedic Surgery Clinic, Seoul, Korea.

Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

出版信息

Clin Orthop Surg. 2025 Apr;17(2):324-330. doi: 10.4055/cios24338. Epub 2025 Mar 14.

DOI:10.4055/cios24338
PMID:40170786
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11957828/
Abstract

BACKGROUND

The tibiofibular syndesmosis is essential for preserving the stability of the ankle. Acute syndesmotic injuries with evident or latent instability usually warrant surgical interventions. This cadaveric study examines and compares biomechanical characteristics between the following treatments for syndesmosis injuries: suture-button fixation plus syndesmotic repair and screw fixation.

METHODS

The lower extremities of 10 cadavers disarticulated at the knee joints were used, yielding 20 feet. Ten feet underwent surgery using the suture-button fixation with syndesmotic repair, while the remaining 10 feet underwent surgery using screw fixation. Before surgical treatment of syndesmosis injuries, each cadaveric lower limb underwent preliminary physiological cyclic loading, which was followed by a series of postfixation cyclic loading tests after the surgical procedure.

RESULTS

Our principal finding is that suture-button fixation with syndesmotic repair provided torsional strength comparable to that of screw fixation. The mean failure torque did not differ between the 2 groups, but the rotational stiffness was significantly lower in the suture-button fixation/augmentation group.

CONCLUSIONS

Suture-button fixation/augmentation facilitates flexible (physiological) syndesmosis movement and may be a useful alternative treatment for ankle syndesmosis injury.

摘要

背景

胫腓下联合对于维持踝关节的稳定性至关重要。伴有明显或潜在不稳定的急性下联合损伤通常需要手术干预。本尸体研究检查并比较了以下下联合损伤治疗方法之间的生物力学特征：缝线纽扣固定联合下联合修复与螺钉固定。

方法

使用10具在膝关节处离断的尸体下肢，共得到20只足。10只足采用缝线纽扣固定联合下联合修复进行手术，其余10只足采用螺钉固定进行手术。在下联合损伤手术治疗前，对每具尸体下肢进行初步的生理循环加载，手术操作后进行一系列固定后循环加载测试。

结果

我们的主要发现是，缝线纽扣固定联合下联合修复提供的抗扭强度与螺钉固定相当。两组的平均失效扭矩无差异，但缝线纽扣固定/增强组的旋转刚度显著更低。

结论

缝线纽扣固定/增强有利于下联合灵活（生理性）活动，可能是踝关节下联合损伤的一种有用的替代治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/efda63ac469e/cios-17-324-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/44618381afc5/cios-17-324-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/ee04a3470ce7/cios-17-324-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/454f171946eb/cios-17-324-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/741ccf533d8e/cios-17-324-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/9714a05a83f7/cios-17-324-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/efda63ac469e/cios-17-324-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/44618381afc5/cios-17-324-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/ee04a3470ce7/cios-17-324-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/454f171946eb/cios-17-324-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/741ccf533d8e/cios-17-324-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/9714a05a83f7/cios-17-324-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a932/11957828/efda63ac469e/cios-17-324-g006.jpg

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本文引用的文献

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Medicina (Kaunas). 2023 Mar 25;59(4):652. doi: 10.3390/medicina59040652.
2
Biomechanics of the Distal Tibiofibular Syndesmosis: A Systematic Review of Cadaveric Studies.下胫腓联合的生物力学：尸体研究的系统综述
Foot Ankle Orthop. 2021 Jun 4;6(2):24730114211012701. doi: 10.1177/24730114211012701. eCollection 2021 Apr.
3
Suture button versus syndesmotic screw in ankle fractures - evaluation with 3D imaging-based measurements.
缝合钉与踝关节骨折的下胫腓螺钉固定：基于三维成像测量的评估。
BMC Musculoskelet Disord. 2021 Nov 22;22(1):970. doi: 10.1186/s12891-021-04834-0.
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Comparison of Open Anterior Syndesmotic Repair Augmented With Suture-Tape and Trans-syndesmotic Screw Fixation: A Biomechanical Study.前联合开放式修复增强缝合带与经联合固定螺钉固定的比较：一项生物力学研究。
J Foot Ankle Surg. 2021 Mar-Apr;60(2):339-344. doi: 10.1053/j.jfas.2020.04.021. Epub 2020 Nov 25.
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Does the choice of syndesmotic screw versus suture button in ankle surgery has a silver lining? - a technical note.踝关节手术中联合加压螺钉与缝合纽扣的选择是否存在一线希望？——技术说明
J Exp Orthop. 2020 Sep 13;7(1):66. doi: 10.1186/s40634-020-00279-x.
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Foot Ankle Int. 2020 Oct;41(10):1256-1268. doi: 10.1177/1071100720936596. Epub 2020 Jul 16.
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