摘要
目的探讨经皮三角形自体半腱肌肌腱移植、距跟外侧韧带(LTCL)功能重建联合距腓前韧带(ATFL)、跟腓韧带(CFL)解剖重建治疗严重踝关节外侧不稳的临床疗效。方法回顾性分析南部战区总医院收治的26例严重踝关节外侧不稳患者的临床资料,患者均采用经皮自体半腱肌肌腱移植、LTCL功能重建联合ATFL及CFL解剖重建手术。测量患者踝关节最大主动背伸及跖屈活动角度,记录Rudert踝关节外侧副韧带重建评分和美国足踝外科协会(AOFAS)踝与后足功能评分,结合主观客观检查和影像学表现,对手术疗效进行评估。结果平均随访时间(16.8±5.2)个月(12~24个月)。末次随访时患者踝关节最大主动背伸及跖屈活动度与术前相似(P>0.05);Rudert评分、AOFAS评分分别由术前的(55.8±5.0)、(55.3±6.4)分改善为末次随访的(92.3±4.0)、(90.3±3.5)分,手术前后比较,差异有统计学意义(P<0.05)。末次随访时所有客观检查(踝关节前抽屉试验及内翻应力试验、距下关节滑移试验、跟骨横向错位试验及跟骨内翻内旋应力试验)均为阴性,随访期间无一例患者出现踝关节不稳或扭伤,未有距下关节疼痛并发症发生。结论采用经皮三角形自体半腱肌肌腱移植、LTCL功能重建联合ATFL及CFL解剖重建术式操作简单,安全可靠,可以很好地恢复踝关节及距下关节的稳定性,是治疗严重踝关节外侧不稳的较好选择。
Objective To investigate the clinical efficacy of percutaneous triangle shaped semitendinosus tendon autografting,functional reconstruction of lateral talocalcaneal ligament(LTCL)combined with anatomic reconstruction of anterior talofibular ligament(ATFL)and calcaneofibular ligament(CFL)for the treatment of severe lateral ankle instability.Methods Clinical data of 26 patients with severe ankle lateral instability who treated by percutaneous semitendinosus tendon autografting,LTCL functional reconstruction and ATFL,CFL anatomic reconstruction in General Hospital of Southern Theatre Command were retrospectively analyzed.The maximum active dorsiflexion and plantar flexion angles of ankle joint were measured,Rudert score of lateral collateral ligament reconstruction,ankle hindfoot score of American Orthopedic Foot and Ankle Society(AOFAS)as well as objective,subjective examinations and X-ray imaging were used to evaluate the clinical outcomes.Results Patients were followed up for an average of(16.8±5.2)months(12-24 months).The maximal active dorsiflexion and plantar flexion angles of ankle joint at the latest follow-up were similar to the preoperative ones(P>0.05).Rudert scores and AOFAS scores were(55.8±5.0)and(55.3±6.4)points preoperatively,and(92.3±4.0)and(90.3±3.5)points postoperatively,respectively.There were statistical significances between preoperative and postoperative ones(P<0.05).All objective examinations including ankle drawer test,ankle inversion stress test,subtalar glide test,calcaneal lateral dislocation test and calcaneal varus stress test were negative at the latest follow-up.During the follow-up,no patients suffered from ankle instability,ankle sprain or subtalar joint pain.Conclusion Percutaneous semitendinosus tendon autografting,LTCL functional reconstruction combined with anatomic reconstruction of ATFL and CFL is a good choice for severe lateral ankle instability due to its easy and safe procedure,as well as good recovery of the stability of ankle and subtalar joint.
作者
区永亮
李凭跃
黄华扬
张涛
夏远军
王庆
沈洪园
孔令闯
涂强
夏虹
OU Yongliang;LI Pingyue;HUANG Huayang;ZHANG Tao;XIA Yuanjun;WANG Qing;SHEN Hongyuan;KONG Lingchuang;TU Qiang;XIA Hong(Department of Orthopaedics,Guangdong Key Lab of Orthopaedic Technology and Implant,General Hospital of Southern Theatre Command,Guangzhou,Guangdong 510010,China)
出处
《中国骨科临床与基础研究杂志》
2021年第1期34-39,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
基金
广州市科技计划项目(201804010136)。
关键词
踝关节损伤
关节不稳定性
外侧韧带
踝
距跟外侧韧带
距腓前韧带
跟腓韧带
移植
自体
修复外科手术
Ankle joint
Joint instability
Lateral ligament,ankle
Lateral talocalcaneal ligament
Anterior talofibular ligament
Calcaneofibular ligament
Transplantation,autologous
Reconstructive surgical procedures
