Tightrope系统捆绑弹性固定下胫腓分离新技术的初步研究  

Elastic fixation with Tightrope system for inferior tibiofibular syndesmosis diastasis:a cadaveric study

作　　者：赛佳明 郑良孝 于良宁 刘金伟 朱朝晖 张增方 Sai Jiaming;Zheng Liangxiao;Yu Liangning;Liu Jinwei;Zhu Zhaohui;Zhang Zengfang(Department of Hand and Foot Surgery,Qilu Hospital(Qingdao),Cheeloo College of Medicine,Shandong University,Qingdao 266035,Shandong,China;Department of Image Center,Qilu Hospital(Qingdao),Cheeloo College of Medicine,Shandong University,Qingdao 266035,Shandong,China)

机构地区：[1]山东大学齐鲁医院(青岛)手足外科,266035 [2]山东大学齐鲁医院(青岛)影像中心,266035

出　　处：《中华创伤骨科杂志》2020年第10期901-907,共7页Chinese Journal of Orthopaedic Trauma

基　　金：青岛市医疗卫生重点学科建设项目。

摘　　要：目的评估自行设计的Tightrope绊钢板线缆系统(Tightrope系统)捆绑弹性固定下胫腓联合(ITFS)分离的安全性。方法本研究为自身前-后对照研究,选用6具正常成人踝关节尸体标本作为ITFS正常组,建立下胫腓联合分离模型作为ITFS分离组。在ITFS分离模型上依次采用Tightrope系统行横向弹性固定和捆绑弹性固定作为Tightrope系统横向弹性固定组(横向固定组)和Tightrope系统捆绑弹性固定组(捆绑固定组)。通过对重力应力试验X线片上测量的相关指标[下胫腓间隙(TFCS)、踝关节内侧间隙(MCS)]和CT线片上测量的相关指标[下胫腓前、中、后间距(ITFACS、ITFMCS、ITFPCS)、下胫腓前缘水平间距(AITF)、腓骨旋转角度(θfib)]进行比较,评估Tightrope系统捆绑弹性固定与横行弹性固定对下胫腓联合分离复位及稳定性作用的差异。结果在标本上采用Tightrope系统横向弹性固定下胫腓联合对腓骨、下胫腓骨间韧带及腓动脉穿支产生医源性损伤,且复位不良,采用Tightrope系统捆绑弹性固定不会造成下胫腓前、后韧带及腓骨肌腱上支持带损伤,且准确复位。4组间TFCS、踝关节MCS、ITFACS、ITFMCS、AITFI比较:ITFS正常组<捆绑固定组<横向固定组<ITFS分离组,4组间ITFPCS比较:横向固定组<捆绑固定组<ITFS正常组<ITFS分离组,4组间θfib比较:ITFS正常组<捆绑固定组<ITFS分离组<横向固定组,以上两两比较差异均有统计学意义(P<0.05)。结论与Tightrope系统横向弹性固定比较,Tightrope系统捆绑弹性固定手术路径更安全、复位更准确、稳定性更好。Objective To study the performance of the elastic fixation with our self-designed Tightrope system for inferior tibiofibular syndesmosis(ITFS)diastasis.Methods In this self-control study,6 specimens of normal cadaveric ankle were used as a normal ITFS group while the models of the ITFS diastasis were constructed as a group of ITFS diastasis.On the models of ITFS diastasis,elastic fixation with transverse Tightrope system(transverse fixation group)or binding Tightrope system(binding fixation group)was applied.The reduction and stability of ITFS were compared between transverse fixation and binding fixation for ITFS diastasis in terms of ITFS parameters on X-Ray[tibiofibular clear space(TFCS)and medial clear space(MCS)]and on CT[inferior tibiofibular anterior clear space(ITFACS),inferior tibiofibular middle clear space(ITFMCS),inferior tibiofibular posterior clear space(ITFPCS),anterior inferior tibiofibular interval(AITFI)and fibular rotation(θfib)].Results The transverse fixation with Tightrope system for ITFS diastasis on the models led to iatrogenic injury to the fibular and the ITFS interosseous ligaments and to the perforating peroneal artery,and malreduction as well while the binding fixation with Tightrope system caused no injury to the anterior or the posterior ITFS ligament or the superior peroneal retinaculum but fine reduction as well.In comparisons of TFCS,ankle MCS,ITFACS,ITFMCS and AITFI between the 4 groups,normal ITFS group<binding fixation group<transverse fixation group<ITFS diastasis group;in comparison of ITFPCS between the 4 groups,transverse fixation group<binding fixation group<normal ITFS group<ITFS diastasis group;in comparison ofθfib between the 4 groups,normal ITFS group<binding fixation group<ITFS diastasis group<transverse fixation group.Significant differences were shown in all the pairwise comparisons(P<0.05).Conclusion The binding fixation with our self-designed Tightrope system may be superior to the transverse fixation in surgical approach and reduction and stability of ITFS.

关 键 词：踝关节 解剖学 尸体 下胫腓联合 弹性固定 

分 类 号：R687.3[医药卫生—骨科学]