Suture anchor fixation realizes the physiological reconstruction and repair of tibiofibular syndesmotic injury

doi:10.3969/j.issn.2095-4344.2013.30.008

Abstract

Abstract:

BACKGROUND: The traditional surgical method have large trauma in the treatment of tibiofibular syndesmosis injury, and cannot well complete the repair of ligament. But the suture anchor has clear effect for ligament repair, ligament reconstruction and bone connection.
OBJECTIVE: To investigate the biomechanical properties of the suture anchor in the treatment of tibiofibular syndesmotic injury, and to compare with lag screw internal fixation.
METHODS: Eight ankle joint specimens were collected, and the biomechanical experiment was performed for stress analysis. The suture anchor technology and lag screw internal fixation were used respectively to treat the tibiofibular syndesmotic injury. The biomechanical properties of the stress strength, stiffness and stability were compared.
RESULTS AND CONCLUSION: The biomechanical properties of the stress strength, stiffness and stability of suture anchor technology for the treatment of tibiofibular syndesmotic injury were better than those of lag screw internal fixation, and there were significant differences in the strength and stiffness between two methods (P < 0.05); the stress shielding rate of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P < 0.05); the tibiofibular syndesmosis separated displacement of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P < 0.05). The results indicate that the suture anchor technology is a minimal invasion and good method to realize physiological reconstruction and elastic fixation with stable fixation strength and less trauma, and without secondary operation.

Key words: bone and joint implants, orthopedic implants, ankle joint, inferior tibiofibular, tibiofibular syndesmosis ligament, tibiofibular syndesmosis injury, suture anchor technology, lag screw, internal fixation, biomechanical tests

CLC Number:

R318

Tang Feng, Wang Qin-ye, Xu Zhong-liang, Luo Ya-ping, Chang Xiao-bo, Wang Yi-jin. Suture anchor fixation realizes the physiological reconstruction and repair of tibiofibular syndesmotic injury [J]. Chinese Journal of Tissue Engineering Research, 2013, 17(30): 5466-5471.

Figures/Tables 6

当下胫腓联合韧带损伤后，胫腓骨的水平移位达0.82 mm，纵向移位达2.98 mm，跖屈位移达2.82 mm，足的轴向刚度下降8%以上，形成踝关节轻度不稳定状态，当骨间膜合并损伤时，胫腓骨的水平移位增大到4.64 mm，纵向移位在5.12 mm以上时，跖屈位达到 4.68 mm，足的轴向刚度下降35%以上。形成重度不稳定，此时必须予以坚强手术内固定。踝关节下胫腓联合损伤采用缝合锚技术治疗后，胫腓骨水平移位减小到0.22 mm，纵向移位仅为0.39 mm，比损伤时水平移位和纵向移位恢复了61%和78%。而跖屈位的位移仅为0.34 mm，恢复了76%以上，足的轴向刚度得以恢复90%以上，已经维持了踝关节的稳定性。如果采用拉力螺钉内固定，下胫腓的水平移位和纵向移位分别为0.38 mm和0.72 mm，此损伤时仅恢复了28%和32%，而跖屈位的移位为0.64 mm，仅恢复了56%，而足的刚度仅恢复40%左右，并未达到踝关节稳定性要求。虽然维持了踝关节的轻度稳定性，但并不彻底，由于拉力螺钉固定，蹊跷不平，固定并不牢固；而采用缝合锚技术，与拉力螺钉组的分离位移相比，分别相差42%、46%和44%，差异有显著性意义(t=3.764， P < 0.05)。充分证明缝合锚技术固定下胫腓联合损伤的优越性。 2.4 下胫腓联合损伤内固定的应力遮挡效应这里的应力遮挡，是指胫腓骨的正常应力被固定物所遮挡，造成骨吸收或骨不愈合，这是因为器械内固定物的弹性模量与骨的弹性模量相差太悬殊，在骨上的正常生理应力被器械所代替遮挡。造成机械应力与骨组织之间、骨质增生与吸收相互不平衡。一般合理的固定，能消除有害应力，发挥正常的应力刺激作用，此时应力遮挡效应是很小的。应力遮挡理论上可用力学公式加以表示[12]："

References

[1] 李庭,蒋协远,王满宜,等.合并踝关节骨折的下胫腓分离[J].中华骨科杂志,2004,24(6):372-375.

[2] Edwards GS, Delee JC. Ankle diastases without fracture. Foot Ankle Int. 1984;5(5):305-312.

[3] 荣国威,王承武. 骨折[M]. 北京:人民卫生出版社,2004: 1167-1168.

[4] Harper MC, KeIIer TS. A radiogrsphic evaluation of the tibiofibular syndsesmosis. Foot Ankle Int. 1989;10(3): 156-160.

[5] Pneumatics SG, Noble PC, Chatziioannou SN, et al. The effects of rotation on radiographic eveluation of the tibiofibular syndesmosis. Foot Ankle Int. 2002;23(2):107-111.

[6] Kennedy MA,Sama AE,Sigman M. Tibiofibular syndesmosis and ossification. Case report: sequelae of ankle sprain in an adolescent football player. J Emerg Med. 2000;18(2): 233-240.

[7] Griend RV,Michelson JD,Bone LB. Fracture of the ankleand distal part of the tibia. J Bone Joint Surg. 1996;78A:1772- 1783.

[8] Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995;77A:142-152.

[9] 王以进,王介麟. 骨科生物力学[M].北京:人民军医出版社,1989: 171-174.

[10] Brown KW, Morrison WB, Schweitzer ME, et al. MRI findings associated with distal tibiofibular syndesmosis injury. AJR Am J Roentgenol. 2004;182(1):131-136.

[11] Sri-Ram K, Robinson AH. Arthroscop in assessment of the syndesmosis following ankle fracture. Injury. 2005;36(5): 675-678 .

[12] 王以进.应力遮挡效应的理论基础和影响因素[J]. 医用生物力学杂志,1993,8(3):187-188.

[13] 李丹,卡索,刘成. 急性下胫腓联合损伤的诊治体会[J].中国矫形外科杂志, 2005,13(22):1754.

[14] 秦煜, Henry DeGroot Ⅲ. Suture Button装置修复下胫腓联合损伤的初步报告[J].中国矫形外科杂志,2008,16(22): 1686-1687.

[15] 王勤业,罗亚平,张德常,等. 缝合锚技术治疗肩锁关节脱位的功能生物力学研究[J]. 中国骨与关节损伤,2009,24(5):289-392.

[16] 丁占去,王文庆,荣国威. 踝关节骨折脱位合并下胫腓分离的治疗[J]. 骨与关节损伤杂志,1988,3(1):1-4.

[17] 陆宸照,蔡体栋,曲克服,等. 胫腓下关节分离的治疗[J].中国综合临床,1985,(2): 46-48.

[18] 陈元璋,霍志方,蔡礼德,等.下胫腓联合钩的临床应用及探讨[J].中国矫形外科杂志,1995,2(1):67-68.

[19] 巫智强,朱俊峰,周根本. 应用SR-DGA治疗Maison-neuve骨折[J].实用骨科杂志,2001,7(4):285-286.