Tibiotalar joint dynamics: indications for the syndesmotic screw--a cadaver study.

W C Burns, K Prakash, R Adelaar, A Beaudoin, W Krause
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引用次数: 154

Abstract

Pronation-external rotation ankle injuries involve varying degrees of disruption of the syndesmotic ligaments. The loss of ligament support and alteration in the stability of the mortise have been postulated to lead to an increase in joint reactive forces and traumatic arthritis. The purpose of this study was to determine the changes in tibiotalar joint dynamics associated with syndesmotic diastasis as a result of the sequential sectioning of the syndesmotic ligaments to simulate a pronation-external rotation injury. Dissections were conducted on 10 fresh-frozen, knee-disarticulated cadaveric specimens which were then axially loaded in an unconstrained manner. Tibiotalar joint forces were measured at each level of sequential sectioning of the syndesmotic ligaments, the interosseous membrane, and finally the deltoid ligament. Complete disruption of the syndesmosis with the medical structures of the ankle intact resulted in an average syndesmotic widening of 0.24 mm and no significant change in the tibiotalar contact area or the peak pressure. However, deltoid ligament strain increases with sectioning of the syndesmosis. With the addition of deltoid ligament sectioning, there was an average syndesmotic diastasis of 0.73 mm, a 39% reduction in the tibiotalar contact area, and a 42% increase in the peak pressure. In a simulated unconstrained cadaveric model of a pronation-external rotation ankle injury that results in complete disruption of the syndesmosis, if rigid anatomic medial and lateral joint fixation is obtained and the deltoid ligament complex is intact, syndesmotic screw fixation is not required to maintain the integrity of the tibiotalar joint.

胫距关节动力学:联合螺钉的适应症——一项尸体研究。
旋前-外旋踝关节损伤包括不同程度的联合韧带断裂。韧带支持的丧失和榫卯稳定性的改变被认为会导致关节反应力和创伤性关节炎的增加。本研究的目的是确定在模拟前旋-外旋损伤时对韧带联合进行连续切片后与胫腓关节动力学相关的变化。对10个新鲜冷冻,膝关节脱臼的尸体标本进行了解剖,然后以无约束的方式轴向加载。在韧带联合韧带、骨间膜和三角韧带的顺序切片的每个水平上测量胫距关节力。在踝关节医学结构完整的情况下,韧带联合完全断裂,导致韧带联合平均增宽0.24 mm,胫距接触面积或峰值压力无明显变化。然而,三角韧带的劳损随着韧带联合的切开而增加。加上三角韧带切片,韧带联合分离平均为0.73 mm,胫距接触面积减少39%,峰值压力增加42%。在模拟无约束的前旋-外旋踝关节损伤的尸体模型中,如果获得了僵硬的解剖性内外侧关节固定并且三角韧带复合体完好,则不需要螺钉固定来维持胫距关节的完整性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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