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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study
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Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

机译：受控踝关节步行靴对负重过程中下颌联合稳定性的影响：一项尸体研究

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Background: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries. Purpose: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model. Study Design: Controlled laboratory study. Methods: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used. Results: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005). Conclusion: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments. Clinical Relevance: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.
机译：背景：上颌联合损伤可能导致长期并发症。因此，他们需要仔细的管理。当1个下颌联合韧带受伤时，保守治疗是足够的，但是当3个下颌联合韧带破裂时，通常需要手术以达到关节全合。但是，对于2韧带损伤的最佳治疗方法存在一些争议。目的：在尸体模拟承重模型中，评估控制脚踝运动（CAM）步行靴对医源性孤立性前胫腓下韧带（AiTFL）损伤和AiTFL /骨间韧带（IOL）合并损伤后的下突联合不稳定的影响。研究设计：受控实验室研究。方法：解剖十具尸体标本，以暴露出胫骨平台和胫骨联合。将样品安装到定制设备上，并施加可重复的750 N轴向载荷。下颌韧带（AiTFL + IOL）的医源性破裂是顺序进行的。比较有无轴向负荷（AL）和CAM引导时未受伤的肌群，孤立的AiTFL破裂以及合并的AiTFL / IOL破裂。使用先前验证的计算机断层扫描扫描测量系统评估胫腓远端关系。使用了配对样品和非参数数据的Wilcoxon检验。结果：AL期间在胫骨远端腓骨关系中唯一注意到的差异是使用CAM靴时腓骨外旋的增加。 AiTFL破裂（8.40°vs. 11.17°; P = 0.009）和AiTFL / IOL合并破裂（8.81°vs 11.97°; P = 0.005）观察到了这一点。结论：即使2条韧带破裂，AL也不会引起胫骨和腓骨之间的明显移位。但是，CAM保护套产生了明显的外部旋转，带有1或2个受伤的韧带。临床意义：需要进一步的研究来评估CAM步行靴的功能，以防止在将外部旋转力施加到脚踝时误导。此外，在安装CAM防尘套期间应格外小心，以免气垫过度充气。

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