伴随踝关节外侧韧带损伤和韧带联合损伤的患病率很高。然而,尚不清楚联合韧带是否直接有助于踝关节外侧的稳定性。因此,这项研究的目的是通过透视评估联合韧带在稳定踝关节外侧中的作用。
将24具尸体标本分为3组,并在所有联合韧带和踝关节韧带完整的情况下进行透视检查以评估踝关节外侧稳定性,然后进行系列差异韧带横切。第1组:(1)距腓前韧带(ATFL),(2)跟胫韧带(CFL),和(3)距腓后韧带(PTFL)。第2组:(1)下胫腓前韧带(AITFL),(2)骨间韧带(IOL),(3)下胫腓后韧带(PITFL),(4)ATFL,(5)CFL,和(6)PTFL。第3组:(1)AITFL,(2)ATFL,(3)CFL,(4)IOL,(5)PTFL,(6)PITFL。在每个横切状态下,使用3种加载条件:(1)使用50和80N的直接力进行前抽屉试验,(2)距骨倾角<1.7Nm扭矩,和(2)横向净空(LCS)<1.7Nm扭矩。然后将这些测量值与应力完整韧带状态的测量值进行比较。使用Wilcoxon秩和检验将每种韧带横切状态与完整状态的发现进行比较。P值<0.05被认为具有统计学意义。
横切所有联合韧带后,踝关节外侧保持稳定(AITFL,IOL,PITFL).然而,在额外的ATFL横切后,在内翻和前抽屉测试条件下,踝关节外侧变得不稳定(P值范围为.036至.012)。在内翻和前抽屉测试条件下(P值范围为.036至.012),横切ATFL和AITFL后,也观察到了踝关节的外侧不稳定。随后的CFL和PTFL横切加重了踝关节外侧的不稳定性。
我们的研究结果表明,孤立的关节连接破坏不会导致踝关节外侧不稳定。然而,当关节联合损伤和ATFL破坏时,外侧踝关节变得不稳定。
当与ATFL释放结合使用时,连骨的破坏似乎使外侧踝关节不稳定。
There is a high prevalence of concomitant lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Therefore, the aim of this study was to fluoroscopically evaluate the role of the syndesmotic ligaments in stabilizing the lateral ankle.
Twenty-four cadaveric specimens were divided into 3 groups and fluoroscopically evaluated for lateral ankle stability with all syndesmotic and ankle ligaments intact and then following serial differential ligamentous transection. Group 1: (1) anterior talofibular ligament (ATFL), (2) calcaneofibular ligament (CFL), and (3) posterior talofibular ligament (PTFL). Group 2: (1) anterior inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), (3) posterior inferior tibiofibular ligament (PITFL), (4) ATFL, (5) CFL, and (6) PTFL. Group 3: (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL. At each transection state, 3 loading conditions were used: (1) anterior drawer test performed using 50 and 80 N of direct force, (2) talar tilt <1.7 Nm torque, and (2) lateral clear space (LCS) <1.7 Nm torque. These measurements were in turn compared with those of the stressed intact ligamentous state. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A P value <.05 was considered statistically significant.
The lateral ankle remained stable after transection of all syndesmotic ligaments (AITFL, IOL, PITFL). However, after additional transection of the ATFL, the lateral ankle became unstable in varus and anterior drawer testing conditions (P values ranging from .036 to .012). Lateral ankle instability was also observed after transection of the ATFL and AITFL in varus and anterior drawer testing conditions (P values ranging from .036 to .012). Subsequent transection of the CFL and PTFL worsened the lateral ankle instability.
Our findings suggest that isolated syndesmosis disruption does not result in lateral ankle instability. However, the lateral ankle became unstable when the syndesmosis was injured along with ATFL disruption.
When combined with ATFL release, disruption of the syndesmosis appeared to destabilize the lateral ankle.