不同复位方式对下胫腓联合复位的效果评价

Evaluation of the reduction effect of different reduction methods on distal tibiofibular syndesmosis

目的研究不同加压方法对下胫腓联合复位质量的影响。方法2022年11月选取深圳大学医学院解剖学系9例成人小腿作为标本,采用切断下胫腓前韧带、骨间韧带、下胫腓后韧带制作下胫腓联合损伤模型。使用点状复位钳分别自不同角度[中心点钳夹(middle),腓骨前缘至胫骨后缘(posterior to anterior,PA),腓骨后缘至胫骨前缘(anterior to posterior,AP)]钳夹以及手握复位法进行复位,并采用克氏针临时固定。固定完成后,透视正位踝穴位X线片及CT扫描,以X线片测量下胫腓间隙(tibio fibular clearspace,TFCS)、内踝间隙(media clear space,MCS),CT测量腓骨移位及腓骨旋转角度。结果MCS测量:正常组(1.9±0.2)mm,切断组(2.0±0.2)mm,Middle组(2.0±0.2)mm、PA组(2.1±0.2)mm、AP组(2.1±0.2)mm,M组(2.0±0.2)mm(F=1.540,P=0.200)。TCS:正常组(3.8±0.5)mm,切断组(3.8±0.5)mm,Middle组(4.2±0.6)mm、PA组(4.4±0.9)mm、AP组(4.0±0.7)mm,M组(3.9±0.6)mm(F=-0.517,P=0.612)。以腓骨旋转定义复位不良:Middle组与PA组进行卡方检验,x^(2)=4.000,P=0.046。PA组与M组进行卡方检验,x^(2)=4.000,P=0.046。其余组间对比差异无统计学意义。以腓骨移位距离定义复位不良:Middle组1例(11.11%)复位不良,PA组5例(55.56%)复位不良,AP组3例(33.33%)复位不良,组间对比差异无统计学意义(P>0.05)。结论点状复位钳夹位置会影响下胫腓联合的复位,其中以腓骨后方至内踝前方的钳夹方向最有可能造成复位不良,故在采用复位钳钳夹下胫腓联合复位时需考虑这一因素,以避免复位不良的发生。

Objective To study the effect of different methods on the reduction quality of syndesmosis.Methods November 2022 nine adult leg specimens from department of anatomy,School of Medicine,Shenzhen University were used to create syndesmosis separation model by cutting off the anterior tibiofibular ligament,interosseous ligament,and posterior tibiofibular ligament.Use reduction clamp from different angles(Middle at the center point,PA from the anterior edge of the fibula to the posterior edge of the tibia,AP from the posterior edge of the fibula to the anterior edge of the tibia)and manual reduction methods.When reduction was done,Kirschner wire was used to fix the position.Fluoroscopy and CT scan were performed to measure tibiofibular space(TFS),Medial clear space(MCS)and displacement and rotation angle of the fibula.Results MCS in normal group(1.9±0.2)mm,Syndesmosis cutoff group(2.0±0.2)mm.Middle group(2.0±0.2)mm,PA group(2.1±0.2)mm,AP group(2.1±0.2)mm.M group(2.0±0.2)mm.No statistical difference were found in each groups(F=1.54,P=0.200).TCS in normal group(3.8±0.500)mm,Syndesmosis cutoff(3.8±0.500)mm,Middle group(4.2±0.600)mm,PA group(4.4±0.900)mm,AP group(4.0±0.700)mm,M group(3.9±0.600)mm showed no statistically significant difference(F=-0.517,P=0.612).Definition of malreduction based on fibular rotation:difference were showed between Middle group and the PA group(x^(2)=4.000,P=0.046)and PA group with M group(x^(2)=4.000,P=0.046).There was no statistically significant difference between the other groups.If malreduction defined by fibular displacement in the Middle group,1 case(11.11%)had poor reduction 5 cases(55.56%)in the PA group,and 3 cases(33.33%)in the AP group.There was no statistically significant difference between the groups.Conclusion The position of reduction clamp may affect the reduction quality in syndesmosis separation.The direction of the clamp from anterior edge of the fibula to posterior edge of the medial malleolus is likely to cause malreduction.