20181213运医读书笔记和思考

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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.

美国足踝骨科协会踝关节评分

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.

这篇文章给我的启发：攀钢板的固定方式是无法提供100%的固定，也就是说，攀钢板在一定程度上允许一定范围的微动。而螺钉的固定可以保证更强大的固定和更小的微动。从想象中我们会更倾向于螺钉固定，但是结果却恰恰相反。

我想到汽车的防撞处理，如果汽车变形，车内人员的受伤几率就小，力量的直接传导会导致坚强的内固定反而更容易出现失效。

下一步工作计划：查阅更多文献，看看上述两种固定方式的具体内容。近关节处的联和腱，因存在垂直方向的剪切力，所以 对于联合腱的固定，可能要区别我们之前对骨折钢板固定的理解。