The Functional Consequence of Syndesmotic Joint Malreduction at a Minimum 2-Year Follow-Up
The Functional Consequence of Syndesmotic Joint Malreduction at a Minimum 2-Year Follow-Up
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DOI：
10.1097/bot.0b013e31822a526a
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发表时间：
2012-07-01
影响因子：
2.3
通讯作者：
Sanders, Roy W.
中科院分区：
文献类型：
--
作者：
Sagi, H. Claude;Shah, Anjan R.;Sanders, Roy W.
目的：研究下胫联合复位不良与功能结果之间的相关性。设计：前瞻性评价双侧计算机断层扫描和功能结果评分。设置：I级区域创伤中心。材料和方法：从2004年1月1日至2006年12月31日，681例手术治疗的踝关节骨折中有107例（15.7%）伴有需要复位和固定的下胫腓联合损伤。所有患者可在至少2年postindex程序进行了临床和影像学检查，计算机断层扫描（CT）扫描的两个踝关节（受伤和未受伤），功能结果评分使用的简表肌肉骨骼评估和Olerud/Molander questionnaire.Results：68 107（63.5%）韧带损伤68例患者可用于随访。与对侧未受伤的下胫联合关节相比，27例（39%）出现复位不良（旋转或平移不对称）。15%的开放性下胫联合复位术后CT扫描显示复位不良，而44%（A/B）的闭合性下胫联合复位术后CT扫描显示复位不良（P = 0.11）。下胫腓联合复位不良的患者记录的功能结果评分明显更差（P < 0.05），与韧带联合解剖愈合的患者相比，两种量表的评分均为P < 0.05。结论：至少随访2年，使用简明肌肉骨骼评估量表和Olerud/莫兰德问卷调查。通过术后CT扫描评估，下胫腓联合切开复位导致复位不良率显著降低。基于这些发现，我们建议外科医生不仅在复位操作中直接开放性观察下胫腓联合，而且还应在术后进行CT扫描，并与对侧肢体进行比较。如果发现下胫腓联合复位不良，必须考虑翻修接骨术。
Objective: To examine the correlation between syndesmotic malreduction and functional outcome.Design: Prospective evaluation of bilateral computed tomography scans and functional outcome scores.Setting: Level I regional trauma center.Materials and Methods: From January 1, 2004, to December 31, 2006, 107 of 681 operatively treated ankle fractures (15.7%) had associated syndesmotic injuries requiring reduction and fixation. All patients available at a minimum of 2 years postindex procedure underwent clinical and radiographic examination, computed tomographic (CT) scanning of both ankles (injured and uninjured), and functional outcome scoring using the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires.Results: Sixty-eight of 107 (63.5%) syndesmotic injuries in 68 patients were available for follow-up. Twenty-seven (39%) were malreduced (rotational or translational asymmetry) when compared with the contralateral uninjured syndesmotic joint. Fifteen percent of the open syndesmotic reductions were malreduced on postoperative CT scans, whereas 44% (A/B) of the closed syndesmotic reductions were malreduced on postoperative CT scan (P = 0.11). Patients with a malreduced syndesmosis recorded significantly worse functional outcome scores (P < 0.05) on both the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires when compared with those patients whose syndesmosis had healed in anatomic alignment.Conclusions: At a minimum of 2 years follow-up, patients with malreduced syndesmotic injuries demonstrated significantly worse functional outcome using the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires. Open reduction of the syndesmosis resulted in a substantially lower rate of malreduction when evaluated by postoperative CT scan. Based on these findings, we recommend that surgeons not only perform a direct, open visualization of the syndesmosis during the reduction maneuver, but obtain a postoperative CT scan with comparison to the contralateral extremity as well. If the syndesmosis is found to be malreduced, consideration must be given to revising the osteosynthesis.