Jorge Filippi, Paulina Gutiérrez, José Quezada, Jafet Massri-Pugin, Gonzalo F Bastías, Rodrigo Melo, Catalina Vidal, Rony Silvestre
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引用次数: 0
Abstract
Background: In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane.
Methods: Eleven below-knee cadaveric specimens were used in this study. Proximal traction of the fibula was performed by applying 50 N in the intact state and after sequential transection of the syndesmotic ligaments, anterior talofibular ligament (ATFL), and the calcaneofibular ligament (CFL). At each stage, the proximal displacement of the fibula was measured. One-way repeated measures analysis of variance with post hoc Bonferroni correction was carried out to determine any significant differences between the groups. A P value <.05 was considered statistically significant.
Results: The vertical displacement of the fibula in the intact state, and after sequential transection of syndesmotic ligaments, ATFL, and CFL was 1.96 ± 1.19 mm, 3.96 ± 1.33 mm, 5.9 ± 1.73 mm, and 10.22 ± 2.76 mm, respectively. There was no significant difference in the proximal displacement of the fibula between the intact and the syndesmotic ligaments groups (P < .05). However, when the syndesmotic ligaments were transected in conjunction with ATFL ± CFL, a significant difference was observed compared to the intact state (P < .001).
Conclusion: The complete disruption of syndesmotic ligaments did not significantly increase the proximal displacement of the fibula. However, when the ATFL ± CFL were additionally disrupted, there was a significant increase in the vertical translation of the fibula.
Clinical relevance: To our knowledge, this is the first study describing that LALC plays a paramount role in the vertical stability of the fibula. Concomitant syndesmosis and LALC should be suspected in an axially unstable fibular fracture with a significant proximal displacement.
背景:在不稳定踝关节骨折中,三角肌和韧带联合的作用已被广泛研究。然而,外侧踝关节韧带复合体(LALC)在腓骨垂直稳定性中的重要性尚不确定。鉴于其解剖位置,它应防止腓骨近端移位。本研究旨在评估LALC在稳定腓骨垂直平面上的作用。方法:采用11例膝以下尸体标本进行研究。在完整状态下,在连续横断韧带联合、距腓骨前韧带(ATFL)和跟腓骨韧带(CFL)后,应用50 N进行腓骨近端牵引。在每个阶段,测量腓骨近端位移。采用事后Bonferroni校正进行单向重复测量方差分析,以确定组间是否存在显著差异。结果:腓骨在完整状态下的垂直位移为1.96±1.19 mm,连续横断韧带后的垂直位移为3.96±1.33 mm, ATFL为5.9±1.73 mm, CFL为10.22±2.76 mm。腓骨近端移位在完整韧带组和联合韧带组之间无显著差异(P < 0.05)。然而,当联合ATFL±CFL切除韧带联合时,与完整状态相比,观察到显著差异(P结论:韧带联合完全断裂并没有显著增加腓骨近端位移。然而,当ATFL±CFL被额外破坏时,腓骨的垂直平移明显增加。临床相关性:据我们所知,这是第一个描述LALC在腓骨垂直稳定性中起重要作用的研究。在有明显近端移位的轴向不稳定腓骨骨折中,应怀疑伴发韧带联合和LALC。
期刊介绍:
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine