踝关节骨折急性三角肌损伤:不同修复结构的生物力学分析。

IF 2.4 2区 医学 Q2 ORTHOPEDICS
Foot & Ankle International Pub Date : 2023-09-01 Epub Date: 2023-07-24 DOI:10.1177/10711007231184844
Emilio Wagner, Pablo Wagner, Mario I Escudero, Florencia Pacheco, David Salinas, Alexandre Leme Godoy-Santos, Felipe Palma, Rodrigo Guzmán-Venegas, Francisco Jose Berral-De la Rosa
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引用次数: 0

摘要

背景:三角肌韧带在胫足关节一致性和耦合中的重要性是众所周知的。目前的趋势是在脚踝骨折的急性损伤情况下进行修复;然而,关于如何重建它的信息有限。本研究的目的是在踝关节骨折尸体模型中比较不同的三角肌韧带修复类型。方法:采用16具尸体足-踝-胫骨远端标本。所有样本均制备为旋后外旋踝骨折模型。使用专门设计的框架对每个试样施加轴向载荷和循环轴向旋转。该测试在没有三角肌损伤、三角肌受伤和修复后进行。重建有4种不同的方式(前部、后部、中部和组合)。在模拟承重(WB)和重力应力(GS)射线照片上测量每种情况下的正中净空间(MCS)。在胫骨和距骨中使用反射标记,通过运动分析系统记录运动学,以记录胫骨-距骨的解耦。结果:三角肌损伤后,所有病例的GS片MCS均显著增加,而WB片MCS无增加。修复后,在所有情况下,MCS均正常化。在运动方面,三角肌损伤后,胫足解偶联显著增加。所有孤立的修复都达到了与基线条件相似的胫距解耦值。联合修复显著降低了胫骨与桡骨的解偶联。结论:我们的研究结果表明,三角肌修复恢复了踝关节骨折模型中的胫足耦合机制。孤立的三角肌修复恢复了基线MCS和胫距解耦值。联合修复可能会导致过度约束,从而导致术后僵硬。临床研究需要证明这些结果,并显示临床改善的结果。临床相关性:这项研究有助于找到在急性创伤环境中使用的最佳三角肌修复方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs.

Background: The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.

Methods: Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling.

Results: After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling.

Conclusion: Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.

Clinical relevance: This study helps in finding the optimum deltoid repair to use in an acute trauma setting.

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来源期刊
Foot & Ankle International
Foot & Ankle International 医学-整形外科
CiteScore
5.60
自引率
22.20%
发文量
144
审稿时长
2 months
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
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