| 李姣,孔长旺,李谓林,等.关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带.骨科,2018,9(5): 376-382. |
| 关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带 |
| Arthroscopic ankle lateral ligament anatomic reconstruction with a semitendinosus tendon autograft for chronic ankle instability |
| 投稿时间：2018-06-25 |
| DOI：10.3969/j.issn.1674-8573.2018.05.008 |
| 中文关键词: 慢性踝关节不稳 侧副韧带 解剖重建 关节镜检查 |
| 英文关键词: Chronic ankle stability Collateral ligaments Anatomic reconstruction Arthroscopy |
| 基金项目:湖北省自然科学基金（ZRMS2017000091） |
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| 中文摘要: |
| 目的 探讨关节镜下自体半腱肌肌腱重建踝关节外侧副韧带治疗慢性踝关节不稳定的方法及初期临床疗效。方法 将2015年12月至2017年2月我院收治的16例慢性踝关节不稳定病人纳入研究，其中男14例，女2例，年龄为（28.1±6.4）岁；术前应力位X线片提示距骨倾斜25.5°±5.5°（18°~35°），距骨前移（10.1±1.8） mm（7~14 mm）。采用2.7 mm 30°短踝关节镜经前外侧入路观察，经前外侧辅助入路于腓骨远端和距骨外侧面距腓前韧带足印区制作骨隧道，跟骨外侧壁跟腓韧带止点处经皮透视制作骨隧道，取自体半腱肌肌腱对折编织成“Y”型，将移植物引入骨隧道，腓骨端使用袢钢板悬吊固定，距骨及跟骨端使用5.0 mm界面螺钉固定。术后早期功能锻炼，末次随访应用美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分系统评价踝关节功能；采用疼痛视觉模拟量表（visual analogue scale, VAS）评估疼痛情况；采用Sefton外侧副韧带重建疗效评价系统评估踝关节稳定性。结果 本组16例病人术后随访（16.8±4.3）个月（12~24个月），均于术后3个月恢复正常体育活动，末次随访未观察到踝关节不稳定复发。AOFAS评分为（89.2±4.8）分，VAS评分为（0.7±0.6）分。依据Sefton评价标准：优9例，良5例，可2例，优良率为87.5%。结论 关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带治疗慢性踝关节不稳定的近期疗效理想，并发症较少。 |
| 英文摘要: |
| Objective To evaluate the surgical technique and preliminary clinical outcome of arthroscopic ankle lateral ligament anatomic reconstruction with a semitendinosus tendon autograft for chronic ankle instability. Methods During December 2015 to February 2017, 16 consecutive patients (14 males and 2 females, aged 28.1±6.4 years, range 20-46 years) with chronic ankle instability were treated in our hospital. All patients were evaluated preoperatively with stress X-rays. The talar tilt angle was 25.5°±5.5° (range 18°-35°), and the anterior drawer distance was (10.1±1.8) mm (7-14 mm). The 2.7 mm-30° arthroscope was introduced through the anterolateral portal, and under direct arthroscopic visualization, we preferred to drill tunnels in the fibula and talus via accessory anterolateral portal, and drill tunnel in the calcaneal using percutaneous and fluoroscopy technique. The semitendinosus tendon autograft was passed through tunnels with a suture passer and secured by an Endobutton at fibula and interference screw in talus and calcaneal. Full weight bearing with orthosis started at 4th week postoperatively. At the final follow-up, functional evaluation was carried out according to the hind-foot score by American Orthopedic Foot and Ankle Society (AOFAS), Sefton grading system and visual analogue scale (VAS) score. Complications were also recorded. Results Sixteen patients were followed up with a duration of 16.8±4.3 months (12 to 24 months). No patients experienced any recurrent episodes of ankle instability. The mean AOFAS and VAS scores were 89.2±4.8 and 0.7±0.6, respectively. 87.5% of the patients reported excellent/good functional results according to Sefton grading system (9 excellent, 5 good, and 2 fair). Conclusion Arthroscopic ankle lateral ligament anatomic reconstruction with a semitendinosus tendon autograft is an effective and safe treatment for chronic ankle instability. |
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