双隧道弹性固定下胫腓联合损伤

Double-tunnel elastic fixation for distal tibiofibular syndesmosis rupture

[目的]介绍双束双隧道弹性固定下胫腓联合损伤的手术技术和初步临床结果。[方法]2017年6月~2019年6月,对13例下胫腓联合完全损伤的患者采用Endobutton钢板进行双束双隧道立体仿生弹性固定。先将下胫腓联合解剖复位,然后在踝关节休息位采用定位导向器自腓骨外侧偏后、胫距关节近端3.0 cm处分别朝前内上方和后内方建立两条骨隧道,再将组装好的3枚Endobutton钢板系统分别穿过2个骨隧道,拉紧后打结固定。[结果]13例手术均顺利完成,术后所有患者均获得随访(14.37±5.63)个月,末次随访时健患侧踝关节活动度(range of motion,ROM)差异无统计学意义(P>0.05),AOFAS评分平均(88.76±3.15)分,Mazur评分优良率为92.31%。[结论]双束双隧道弹性固定下胫腓损伤,疗效满意,该固定装置无需在完全负重前取出。

[Objective]To introduce the surgical technique and preliminary clinical outcomes of double-tunnel elastic fixation for distal tibiofibular syndesmosis(DTFS)rupture.[Methods]From June 2017 to June 2019,13 patients received double-tunnel elastic fixation with Endobutton and suture loops for complete DTFS rupture.After the DTFS was anatomical reduced,the two tibiofibular bone tunnels were established from the fibular side 3.0 cm above the tibiotalar joint,anterosuperiorly and posteroinferiorly to the tibial side respectively with the guider device at rest position of the ankle.Subsequently,suture loops were introduced to pass through the bone tunnels and attach with 3 Endobuttons,one on the fibular side and two on the tibial side.The suture loops were tightened to site the Endobuttons on the cortical bones firmly,and fixed with knots.[Results]All 13 patients had operation successfully completed,and were followed up for(14.37±5.63)months on average.At the latest follow up,there was no statistical difference in the ankle ROM between the surgical side and the healthy side(P>0.05),the average AOFAS score was of(88.76±3.15)points.Based on Mazur criteria,the excellent and good rate of clinical outcomes was of 92.31%.[Conclusion]This double-tunnel elastic fixation for complete DTFS injury does achieve satisfactory clinical outcomes,with a benefit of that the fixation device need not to be removed before full-load bearing.