新型下胫腓复位钳的设计与尸体验证△

Design and cadaveric verification of a novel reduction clamp for distal tibiofibular syndesmosis

摘要:

[目的]数字骨科设计符合国人解剖特征的下胫腓联合复位钳，通过尸体解剖对比研究验证复位钳的优越性，为临床应用提供理论基础。[方法] 纳入国人 60 例正常踝关节 CT 数据导入 Mimics 软件，在踝穴上 1.5 cm 水平面标记胫腓骨中心点，胫腓骨中心点连线为中心力线，然后将胫骨内侧面 3 等分，中前 1/3 交点为 P 点，统计分析投射点 O 点与 P 点的关系。以 O 点为中心、直径为 1 cm 画圆，计算圆在胫骨面的曲率，3D 打印圆形夹头，制作复位钳。纳入 10 例新鲜尸体标本，依次分为正常组、损伤组、复位组，对比研究复位钳的效果。[结果] OP 值为 （0.7±0.4） mm，O 点视为 P 点，P 点胫骨面曲率 （1.722±0.025）°，故以 P 点周围解剖为基准制作复位钳。与正常组比较，损伤组胫腓重叠（tibiofibular overlap, TFO）显著减少， 与损伤组比较，复位组 TFO 显著增加 [(7.3±0.5) mm vs (4.8±0.4) mm vs (7.1±0.4), P=0.019]。与正常组比较，损伤组胫腓间隙（tib- iofibular clear space, TFCS） 显著增加，与损伤组比较，复位组 TFCS 显著减小 [(5.3±0.4) mm vs (7.9±0.4) mm vs (5.0±0.6) mm, P= 0.003]。与正常组比较，损伤组内侧净间隙 （medial clear space, MCS） 显著增加，与损伤组比较，复位组 MCS 显著减小 [(3.4± 0.4) mm vs (5.7±0.3) mm vs (3.6±0.3) mm, P=0.032]。与正常组比较，损伤组联合间隙显著增加，与损伤组比较，复位组显著减小 [(3.4±0.3) mm vs (7.1±0.5) mm vs (3.1±0.2) mm, P=0.016]。与损伤组比较，复位组腓骨旋转角度 [(5.8±0.5)° vs (3.8±0.8)°, P=0.026] 显著减小。正常组与复位组 TFO 、TFCS、MCS、联合间隙的差异均无统计学意义（P＞0.05）。[结论]踝穴上 1.5 cm 水平面胫腓骨中心力线位于胫骨内侧前中 1/3 交点处，新型下胫腓复位钳符合国人胫骨内侧解剖特点，夹持效果良好。

Abstract:

[Objective] To design a reduction forceps of distal tibiofibular syndesmosis with the anatomical characteristics of Chinese people through digital orthopedics, and verify its superiority by a cadaveric comparative study, so as to provide theoretical basis for clinical application. [Methods] CT data of 60 normal Chinese ankle joints were imported into Mimics software. The center point of tibiofibula was marked on the horizontal plane 1.5 cm above the ankle point, and the line of tibiofibular center point was the central force line. Then the medial side of the tibia was divided into three equal parts, and the intersection point of the middle and front 1/3 was marked as point P. The relationship between the projection point O and point P was analyzed statistically. A circle 1cm in diameter centered on the O point was drawn, the curvature of the circle on the tibial surface was calculated, and a circular chuck was printed by 3D printing to make the reduction forceps. Ten fresh cadavers were divided into normal group, injured group and reduced group to compare the effect of the reduction forceps. [Results] The OP value was (0.7±0.4) mm, point O was regarded as point P, and the tibial surface curvature of point P was (1.722±0.025)°, so the reduction forceps was made based on the anatomy around point P. Compared with the normal group, the tibiofibular overlap (TFO) in the injured group decreased significantly, while compared with the injured group, the TFO increased significantly in the reduced group [(7.3±0.5) mm vs (4.8±0.4) mm vs (7.1±0.4) mm, P=0.019]. Compared with the normal group, the tibiofibular clear space (TFCS) increased significantly in the injured group, whereas compared with the injured group, TFCS decreased significantly in reduced group [(5.3±0.4) mm vs (7.9±0.4) mm vs (5.0±0.6) mm, P=0.003]. Compared with the normal group, the medial clear space (MCS) in the injured group significantly increased, while compared with the injured group, the MCS in the reduced group decreased significantly [(3.4±0.4) mm vs (5.7±0.3) mm vs (3.6±0.3) mm, P=0.032]. Compared with the normal group, the tibiofibular distance (TFD) in the injured group was significantly increased, while compared with the injured group the TFD in the reduced group was significantly decreased [(3.4±0.3) mm vs (7.1±0.5) mm vs (3.1±0.2) mm, P=0.016]. Compared with the injured group, the fibular rotation angle was significantly declined in the reduced group [(5.8±0.5)° vs (3.8±0.8)°, P= 0.026]. However, there were no significant differences in TFO, TFCS, MCS and TFD between normal group and reduced group (P＞0.05). [Conclusion] The tibiofibular central force point in the horizontal plane 1.5 cm above the ankle point was located at the intersection of the anterior-middle third of the medial tibia.The new type of syndesmotic reduction forceps conforms to the anatomical characteristics of Chinese people, and has good clamping effect.