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

Abstract

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

References

[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.

The experimental research on effectiveness of different internal fixation for tibiofibular connection

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Li Xiaoyu , Zhang Lei , Fu Lei , Li Dongbo , Wang Guoyou. Finite element study on the treatment of Sanders type II calcaneal fracture with three-step reduction method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 65-70.
[2]	Wu Yanfei, Ma Jianxiong, Lu Bin, Wang Ying, Bai Haohao, Jin Hongzhen, Ma Xinlong. Study on the correlation between the reconstruction of grayscale values using CT post-processing technology and the compressive strength of the endplate [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 71-76.
[3]	Luo Ying, Dou Weiyu, Wu Xiaohang, Chen Jingkun, Peng Changgui, Pan Jianying . Risk factors of postoperative complications of calcaneal fractures treated with hippocampal plate internal fixation through minimally invasive method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 83-88.
[4]	Zhang Yue, Cai Xingbo, Zhang Bihuan, Wang Bin, Xu Yongqing. A review of biomechanical studies of wrist after total wrist arthroplasty [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 112-114.
[5]	Huang Hai, Ouyang Jun. Progress in internal fixation for femoral neck fractures in adults [J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 751-753.
[6]	Ouyang Beiping, Ma Xiangyang, Luo Chunshan, Zou Xiaobao, Liang Dongzhu, Lu Tingsheng, Chen Qiling. Biomechanical comparison of horizontal screw-screw crosslink and horizontal rod-rod crosslink in C1-C2 pedicle screw-rod fixation [J]. Chinese Journal of Clinical Anatomy, 2023, 41(5): 588-592.
[7]	Yang Hua, Xiang Lei, Jiang Hongbing, Hu Bingbing, Zeng Canjun, Zhang Bin, Liu Wei. Comparison of clinical efficacy of modified Stoppa approach and modified pararecutus abdominis approach in the treatment of acetabulum fractures [J]. Chinese Journal of Clinical Anatomy, 2023, 41(5): 603-607.
[8]	Lin Wenjie, Sun Xin, Huang Wenhua, Wei Bo, Lin Tao, Liang Zhenming, Zhong Huan, Zhang Xin, Ouyang Hanbin. Biomechanical analysis of hindfoot joint after ankle arthrodesis [J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 212-217.
[9]	Chang Shusen, He Chunnian, Chen Wei, Zhou Jian, Zhang Fang, Nie Kaiyu, Deng Chengliang, Wei Zairong. Application of descending branch of lateral circumflex femoral artery Flow-through flap combined with MIPPO in emergency treatment of Gustilo type IIIC fracture of tibiofibula [J]. Chinese Journal of Clinical Anatomy, 2022, 40(6): 733-737.
[10]	Li Rui, Zhang Renzan, Liu Zhengpeng, Sun He, Zhang Yilong. Effect of different fusion methods on stress response in patients with multi segmental lumbar spinal stenosis combined with lumbar disc herniation [J]. Chinese Journal of Clinical Anatomy, 2022, 40(5): 599-604.
[11]	Wang Tianfang, Cai Li, Shi Haifeng, Yin Qudong, Wu Yongwei. The effect of suture Nice knot tension band combined with lag screw fixation for simple transverse olecranon fracture [J]. Chinese Journal of Clinical Anatomy, 2022, 40(4): 476-479.
[12]	Tong Jie, Ji Wei, Huang Zhiping, Zhou Ruozhou, Fang Zuozhong, Zhu Qingan. Biomechanical study of posterior flexible and dynamic fixations in the occipitocervical region [J]. Chinese Journal of Clinical Anatomy, 2022, 40(3): 315-319.
[13]	Tong Ling, Xu Yangyang, Wang Yidan, Ma Yuan, Wang Haiyan, Li Xiaohe. Finite element analysis of anterior cervical micro-memory compression alloy plate [J]. Chinese Journal of Clinical Anatomy, 2022, 40(3): 320-326.
[14]	Jiang Guanyin, Ou Yunsheng, Zhu Yong, Luo Wei, Du Xing, Zhang Wei, Qin Wanyuan. Study on the curative effects of granular bone graft, titanium mesh bone graft and iliac bone graft in single-segment lumbar tuberculosis focus debridement by posterior approach [J]. Chinese Journal of Clinical Anatomy, 2022, 40(2): 204-210.
[15]	Zhang Weiguo, Yang Na, Yang Jing, Liu Xueqin, Zhao Yunhe. Long-term exercise ameliorates cognitive disorder induced by Aβ1-42 in middle-aged and elderly mice [J]. Chinese Journal of Clinical Anatomy, 2022, 40(1): 39-44.