不同内固定方法对胫腓连结固定效果的实验研究

doi:10.13418/j.issn.1001-165x.2015.04.019

摘要/Abstract

摘要：

目的　探讨胫腓连结的活动度及不同内固定方法对胫腓连结效果的影响。方法　新鲜冷藏的成人小腿标本8侧，常温下解冻，自踝关节离断，剔除皮肤、肌肉等软组织，保留胫腓关节、胫腓连结和骨间膜的完整，置于SWD10万能材料实验机上，测量胫腓连结的正常活动度，完全切断胫腓连结，分别用普通螺丝钉、拉力螺丝钉和“U”形钉固定，测量固定后的活动度。结果　胫腓连结正常的生理活动度为前→后(1.83±0.38) mm、后→前(1.89±0.38) mm、外→内 (1.42±0.34) mm、内→外(1.36±0.65) mm。胫腓连结用普通螺丝钉和拉力螺钉固定后，外踝的活动明显受限，虽然拉力螺钉固定更牢，但二者相差不显著，与正常比较相差非常显著；用“U”形钉固定后，活动度与正常比较相差不显著。结论　胫腓连结是一个具有一定活动度的弹性结构，用螺丝钉固定后活动度明显变小，使用胫腓连结钩或“U”形钉进行弹性固定可保留胫腓连结的生理活动。

关键词: , 胫腓连结, 活动度, 内固定, 生物力学

Abstract:

Objective　 To investigate activity range after the tibiofibular connection and the influence of different internal fixation on tibiofibular connection.　Methods　8 fresh frozen adult leg specimens underwent room temperature thawing, amputation at the ankle and removal of skin, muscle and other soft tissue with the upper and lower tibiofibular joints and the interosseous membrane being kept intact. The processed specimens were then mounted on to a SWD10 universal material experiment machine to measure the physiological activity of tibiofibular activity. In the second step, the fibiotibial connection were completely severed and reestablished with ordinary screws, lag screws, "U" -shaped nail, after which the activity was measured.　Results　The normal physiological activity of tibiofibular connection is (1.83±0.38) mm in the anterior-to-posterior direction, (1.89±0.38) mm in a posterior-to-anterior direction, (1.42±0.34) mm in a lateral-to-medial direction, and (1.36±0.65) mm in a medial-to-lateral direction. After fixation with ordinary screws and lag screws, the activities of the external ankle was significantly limited. Though the lag screws are firmer in fixation, there was no significant difference in terms of activity when compared to that of normal screws fixation. With "U" -shaped nail fixation, no significant compromise in activity was noticed when compared with that of physiological connection.　Conclusions　 Tibiofibular connection if is an elastic structure of a certain activity and activity will decrease significantly after internal fixation with screws. Using the tibiofibular link hook or "U" -shaped nail for elastic fixation may retain the physiological activities.

Key words: Tibial phil link, Activity, Internal fixation, Biomechanics

甘煜东,丁晶,侯春林,黄志伟,徐永清. 不同内固定方法对胫腓连结固定效果的实验研究[J]. 中国临床解剖学杂志, 2015, 33(4): 461-463.

参考文献

[1] Cedell C. Ankle lesions [J]. Acta Orthop Scand,1975,46(15):425-445.
[2] Hopkinson WJ, St.Pierre P, Ryan JB, et al. Syndesmosis sprains of the ankle [J]. Foot Ankle,1990,10(3):325-330.
[3] Rose JD, Flanigan KP, Mlodzienski A. Tibiofibular diastasis without ankle fracture: a review and report of two cases [J]. Foot Ankle Surg, 2002, 41(7):44-51.
[4] 荣国威.下胫腓分离的实验研究 [J]. 中华外科杂志, 1983, 21(5): 5-6.
[5] Ebraheim NA, Taser F, Shafiq Q, et al. Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments [J]. Surg Radiol Anat, 2006, 28(12):142-149.
[6] Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention [J]. Orthop Sports Phys Ther, 2006, 36(7):372-384.
[7] Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clinical relevance [J]. Surg Radiol Anat, 2003, 25(18):379-386.
[8] Richter J, Schulze W, Clasbrummel B, et al. The role of the tibiofibular syndesmotic and the deltoid ligaments in stabilizing Weber B type ankle joint fractures—and experimental investigation [J]. Unfallchirurg, 2003, 106(1):59-66.
[9] Xenos JS, Hopkinson WJ, Mulligan ME. The tibiofibular syndesmosis. Evaluation of the ligaments structures, methods of fixation, and radiographic assessment [J]. Bone Joint Surg Am, 1995, 77(10):847-856.
[10] 钟世镇. 临床应用解剖学 [M]. 北京: 人民军医出版社, 1998:622.
[11] Cox S, Mukherjee DP, Ogden AL, et al. Distal tibiofibular syndesmosis fixation: a cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation [J]. Foot Ankle Surg,2005,44(8):144-151.
[12] Manjoo A, Sanders DW, Tieszer C, et al. Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal [J]. Orthop Trauma,2010,24(7):2-6.
[13] Farhan M J, Smith T W. Fixation of diastasis of the inferior tibiofibular joint using the syndesmosis hook [J]. Injury, 1985,16(10): 309-311.
[14] 景义，张铁良，韩慧，等. 弹性外固定器治疗合并下胫腓损伤的踝关节骨折[J]. 中华骨科杂志，1998,18(3): 525-527.
[15] van den Bekerom MP, Hogervorst M, Bolhuis HW, et al. Operative aspects of the syndesmotic screw: review of current concepts [J]. Injury,2008,39(9):491-498.
[16]Pesl T, Havranek P. Rare injuries to the distal tibiofibular joint in children [J]. Eur J Pediatr Surg,2006,16(21):255-259.
[17]Muhle C, Frank LR, Rand T, et al. Tibiffibular syndesmosis: high-resolution MRI using a local gradient coil [J]. Comput Assist Tomogr,1998,22(11):938-944.
[18] Ebraheim NA, Lu J, Yang H, Mekhail AO, et al. Radiographic and CT evaluation of tibiofibular syndesmosis diastasis: a cadaver study [J]. Foot Ankle Int,1997,18(16):693-698.
[19] Takao M, Ochi M, Naito K, et al. Arthroscopic diagnosis of tibiofibular syndesmosis disruption [J]. Arthroscopy, 2001, 17(8):836-843.

[20] Yoshimura I, Naito M, Kanazawa K, et al. Arthroscopic finding in Maisonneuve fractures [J]. Orthop Sci, 2008, 13(5):3-6.
[21] Kim S, Huh YM, Song HT, et al. Chronic tibiofibular syndesmosis injury of ankle: evaluation with contrast-enhanced fat-suppressed 3D fast spoiled gradient-recalled acquisition in the steady stable MR imaging [J]. Radiology, 2007, 242(27):225-235.
[22] Pajaczkowski JA. Rehabilitation of distal tibiofibular syndesmosis sprains: a case report [J]. Can Chiropr Assoc, 2007, 51(30):42-49.
[23] Bai XD, Xing GY, Yang CD, et al. Operative treatment for separation of distal tibiofibular syndesmosis [J]. Chin J Traumatol, 2006, 9(13):175-180.
[24] Dattani R, Patnaik S, Kantak A, et al. Injuries to the tibiofibular syndesmosis [J]. Bone Joint Surg Br, 2008, 90(21):405-410.
[25] Tornetta P 3rd, Spoo JE, Reynolds FA, et al. Overtightening of the ankle syndesmosis: is it really possible [J]? Bone Joint Surg Am, 2001, 83(35):489-492.
[26] Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions [J]. Foot Ankle Clin, 2008, 13(10):611-633.
[27] Beumer A, Heijboer RP, Fontijne WP, et al. Late reconstruction of the anterior distal tibiofibular synedsmosis: good outcome in 9 patients [J]. Acta Orthop Scand, 2000,71(6):519-521.
[28] van den Bekerom MP, de Leeuw PA, van Di jk CN. Delayed operative treatment of syndesmotic instability. Current concepts review [J]. Injury, 2009, 40(7):1137-1142.
[29] 关夷, 谢汉国, 张宗平. 趾长伸肌腱内侧束转位修复下胫腓联合分离的解剖学基础 [J]. 临床军医杂志, 2000, 28(5): 1-2 .
[30] Ebraheim NA, Mekhail AO, Gargasz SS. Ankle fractures involving the tibular proximal to the distal tibiofibular syndesmosis [J]. Foot Ankle Int, 1997, 18(14):513-521.