BACKGROUND:: Operative treatment is indicated for unstable syndesmosis injuries, and approximately 20% of all ankle fractures require operative fixation for syndesmosis injuries.
PURPOSE:: To perform a meta-analysis of randomized controlled trials evaluating clinical outcomes between suture button (SB) and syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle.
STUDY DESIGN:: Meta-analysis.
METHODS:: A literature search was performed according to the PRISMA guidelines to identify randomized controlled trials comparing the SB and SS techniques for syndesmosis injuries. Level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine. Statistical analysis was performed with RevMan, and a P value ≤.05 was considered statistically significant.
RESULTS:: Five clinical studies were identified, allowing comparison of 143 patients in the SB group with 142 patients in the SS group. Patients treated with the SB technique had a higher postoperative American Orthopaedic Foot & Ankle Society score at a mean 20.8 months (95.3 vs 86.7, P < .001). The SB group resulted in a lower rate of broken implants (0.0% vs 25.4%, P < .001), implant removal (6.0% vs 22.4%, P = .01), and joint malreduction (0.8% vs 11.5%, P = .05) as compared with the SS group.
美國足踝骨科協(xié)會(huì)踝關(guān)節(jié)評分
CONCLUSION:: The SB technique results in improved functional outcomes as well as lower rates of broken implant and joint malreduction. Based on the findings of this meta-analysis, the SB technique warrants a grade A recommendation by comparison with the SS technique for the treatment of syndesmosis injuries.
這篇文章給我的啟發(fā)：攀鋼板的固定方式是無法提供100%的固定，也就是說，攀鋼板在一定程度上允許一定范圍的微動(dòng)浇雹。而螺釘?shù)墓潭梢员ＷC更強(qiáng)大的固定和更小的微動(dòng)埠对。從想象中我們會(huì)更傾向于螺釘固定，但是結(jié)果卻恰恰相反露久。
我想到汽車的防撞處理冲呢，如果汽車變形嗦哆，車內(nèi)人員的受傷幾率就小符喝，力量的直接傳導(dǎo)會(huì)導(dǎo)致堅(jiān)強(qiáng)的內(nèi)固定反而更容易出現(xiàn)失效。
下一步工作計(jì)劃：查閱更多文獻(xiàn)甜孤，看看上述兩種固定方式的具體內(nèi)容协饲。近關(guān)節(jié)處的聯(lián)和腱，因存在垂直方向的剪切力缴川，所以 對于聯(lián)合腱的固定茉稠，可能要區(qū)別我們之前對骨折鋼板固定的理解。
