Assessment of Open Syndesmosis Reduction Techniques in an Unbroken Fibula Model: Visualization Versus Palpation.
Assessment of Open Syndesmosis Reduction Techniques in an Unbroken Fibula Model: Visualization Versus Palpation.
复制标题
未破损腓骨模型中开放性韧带联合复位技术的评估：可视化与触诊。
DOI：
10.1097/bot.0000000000001322
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发表时间：
2019
影响因子：
2.3
通讯作者：
Gardner,MichaelJ
中科院分区：
文献类型：
--
作者：
Pang,EricQuan;Coughlan,Monica;Bonaretti,Serena;Finlay,Andrea;Bellino,Michael;Bishop,JuliusA;Gardner,MichaelJ
目的：这项尸体研究旨在评估通过前外侧入路直接可视化与通过侧向切口触诊韧带联合复位的准确性。方法：获得 10 具尸体标本并进行基线计算机断层扫描 (CT) 扫描。随后，通过横断前下胫腓韧带、后下下胫腓韧带、横韧带、骨间膜和三角韧带来模拟完整的韧带联合损伤。然后要求三名骨科创伤外科医生通过前外侧入路直接观察来减少每个韧带联合。然后将样本稳定并进行还原后 CT 扫描。然后移除固定装置，关闭前外侧暴露，然后要求外科医生仅通过直接外侧入路进行触诊来减少韧带联合。样本再次安装仪器并进行还原后 CT 扫描。使用双尾配对t检验来比较与基线扫描的减少量，显着性设置为P<0.05。结果：与基线扫描相比，通过直接可视化或通过侧向触诊进行的减少量没有统计学上的显着差异。尽管测量结果未达到显着性，但直接观察有外旋和前内侧平移的趋势，触诊有腓骨外旋和后外侧平移的趋势。结论：使用直接观察或触诊评估韧带联合的复位质量没有差异。因此，外科医生在根据个人喜好和其他损伤因素减少韧带联合损伤时可以选择任一技术。
Objectives:This cadaveric study sought to evaluate the accuracy of syndesmotic reduction using direct visualization via an anterolateral approach compared with palpation of the syndesmosis through a laterally based incision.Methods:Ten cadaveric specimens were obtained and underwent baseline computed tomography (CT) scans. Subsequently, a complete syndesmotic injury was simulated by transecting the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, transverse ligament, interosseous membrane, and deltoid ligament. Three orthopaedic trauma surgeons were then asked to reduce each syndesmosis using direct visualization via an anterolateral approach. Specimens were then stabilized and underwent postreduction CT scans. Fixation was then removed, the anterolateral exposure was closed, and the surgeons were then asked to reduce the syndesmosis using palpation only via a direct lateral approach. Specimens were again instrumented and underwent postreduction CT scans. Two-tailed paired t tests were used to compare reductions with baseline scans with significance set at P< 0.05.Results:There was no statistically significant difference between reduction via direct visualization or palpation via lateral approach when compared with baseline scans. Although measurements did not reach significance, there was a tendency toward external rotation, and anteromedial translation with direct visualization, and a trend toward fibular external rotation and posterolateral translation with palpation.Conclusions:There is no difference in reduction quality using direct visualization or palpation to assess the syndesmosis. Surgeons may therefore choose either technique when reducing syndesmotic injures based on personal preference and other injury factors.