【摘要】：目的:探討踝關(guān)節(jié)鏡微創(chuàng)技術(shù)結(jié)合解剖重建距腓前韌帶/跟腓韌帶(ATFL/CFL)治療慢性踝關(guān)節(jié)外側(cè)不穩(wěn)定的療效。方法:自2010年1月至2013年12月共計(jì)52例(52踝)保守治療無效的慢性踝關(guān)節(jié)外側(cè)不穩(wěn)定(ATFL/CFL損傷)患者納入研究,隨機(jī)分為A、B兩組,A組采用改良brostrom法(錨釘-韌帶-骨膜雙重錨定法)縫合修復(fù),B組取自體半腱肌腱行ATFL/CFL雙束解剖重建。對術(shù)前、術(shù)后2年AOFAS足踝評分、患者主觀感覺、VAS疼痛評分、距骨前移及傾斜、踝關(guān)節(jié)活動(dòng)度進(jìn)行評估,對比兩組的療效差異。結(jié)果:平均隨訪34.7月(2~5年),兩組患者均無感染、神經(jīng)損傷、皮緣壞死、后足僵硬等并發(fā)癥,半腱肌腱供區(qū)無不適,末次隨訪無不穩(wěn)定復(fù)發(fā)。術(shù)后2年A、B兩組在踝關(guān)節(jié)跖屈、背伸、外翻活動(dòng)度上無差異,在踝關(guān)節(jié)內(nèi)翻(P=0.025)、距骨傾斜(P=0.025)與前移(P=0.020)改善方面B組優(yōu)于A組,重建相較于修復(fù)顯示出更佳的穩(wěn)定性。AOFAS評分A組由術(shù)前46.90±9.10改善至術(shù)后2年87.15±4.22(P=0.000),B組由術(shù)前46.50±9.95改善至術(shù)后2年93.70±5.00(P=0.000),術(shù)后2年組間比較存在差異(P=0.035)。兩組在疼痛、異常步態(tài)、自主活動(dòng)及功能、前后屈伸活動(dòng)、后足活動(dòng)及對線評分項(xiàng)目上無明顯差異;在地面步行(P=0.045)、最大步行距離(P=0.042)、穩(wěn)定性評分(P=0.045)上組間有差異。VAS視覺疼痛評分A組由術(shù)前7.10±5.30改善至術(shù)后2年2.05±1.95(P=0.000),B組由術(shù)前6.95±4.40改善至術(shù)后2年2.12±1.88(P=0.000),術(shù)后2年組間比較無差異(P=0.450)。主觀評級術(shù)后2年A組優(yōu)良率87.5%,B組95.83%(P=0.001);兩組內(nèi)AOFAS客觀評分與主觀評級相當(dāng),主客觀評價(jià)統(tǒng)一度較好。結(jié)論:依托關(guān)節(jié)鏡技術(shù),借鑒尸體解剖數(shù)據(jù),半腱肌腱雙束解剖重建ATFL/CFL在有效恢復(fù)踝關(guān)節(jié)外側(cè)穩(wěn)定性的同時(shí)避免了后足僵硬等常見并發(fā)癥,尤其適用于功能期望值較高的青壯年患者及韌帶殘端質(zhì)量較差的翻修手術(shù)。手術(shù)切口的改進(jìn)及保殘技術(shù)有助于降低術(shù)區(qū)神經(jīng)損傷幾率,恢復(fù)本體感覺,符合快速康復(fù)的理念,長期隨訪有待于進(jìn)一步觀察。
[Abstract]:Objective: to evaluate the effect of ankle arthroscopy combined with anatomical reconstruction of anterior talofibular ligament / calcaneus fibular ligament (ATFL/CFL) in the treatment of chronic lateral ankle instability. Methods: from January 2010 to December 2013, 52 patients (52 malleolus) with chronic lateral ankle instability (ATFL/CFL) were enrolled in the study. Group A was randomly divided into two groups: group A was treated with modified brostrom method (Anchor ligaments-periosteum double Anchorage) suture repair group B was taken from the semitendinosus tendon to perform ATFL/CFL double bundle anatomical reconstruction. The preoperative and postoperative AOFAS foot and ankle score, subjective sensation and pain score, anterior and oblique talus, ankle motion were evaluated, and the curative effects of the two groups were compared. Results: the average follow-up was 34.7 months (2 ~ 5 years). There was no infection, nerve injury, necrosis of the skin margin, stiffness of the hind foot, no discomfort in the semitendinosus donor area, and no unstable recurrence in the last follow-up. 2 years after operation, there was no difference in flexion, extension and valgus of ankle joint between group A and B, and group B was better than group A in the improvement of ankle joint varus (Pn0. 025), talus tilt (Pn0. 025) and anterior displacement (P0. 020). The stability of reconstruction was better than that of repair. AOFAS score in group A was improved from 46.90 鹵9.10 before operation to 87.15 鹵4.22 (P0. 000) in 2 years after operation. In group B, it was improved from 46.50 鹵9.95 before operation to 93.70 鹵5.00 (P0. 000) in 2 years after operation, and there was a difference between two groups (P0.035). There was no significant difference in pain, abnormal gait, autonomic activity and function, flexion and extension activity, hind foot activity and line score between the two groups. The visual pain score of group A was improved from 7.10 鹵5.30 before operation to 2.05 鹵1.95 (P0. 000) in group B from 6.95 鹵4.40 before operation to 2.12 鹵1.88 (P0. 000) at 2 years after operation, but there was no difference between two groups (P0. 450). The excellent and good rate of group A was 87.5% and that of group B was 95.83% (P0. 001) 2 years after subjective rating, the objective score of AOFAS in both groups was equal to that of subjective rating, and the unity of subjective and objective evaluation was better. Conclusion: based on arthroscopic technique and cadaveric data, hemitendinosus double bundle anatomical reconstruction can effectively restore the lateral stability of ankle and avoid common complications such as posterior foot stiffness. It is especially suitable for young patients with high functional expectation and revision surgery with poor quality of ligament stump. The improvement of surgical incision and the technique of disability preservation are helpful to reduce the probability of nerve injury, restore the proprioceptive sensation, and accord with the idea of rapid recovery. The long-term follow-up needs further observation.
【作者單位】： 濰坊市人民醫(yī)院骨關(guān)節(jié)外科;
【基金】：山東省濰坊市科技局立項(xiàng)課題(編號201104103)
【分類號】：R687.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前6條

1 金舜tb,姜文學(xué),李林,玄東澤,元虎;距腓前韌帶和跟腓韌帶損傷的手術(shù)治療[J];中國矯形外科雜志;2001年11期

2 張力;;跟腓韌帶損傷的磁共振成像評價(jià)[J];中國地方病防治雜志;2014年S2期

3 白露;張文濤;黃偉;張新濤;江長青;李偉;;踝關(guān)節(jié)外側(cè)韌帶的解剖學(xué)觀測及其臨床意義[J];北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2013年05期

4 陳志偉;侯子鑫;戴祝;鄧焱;;自體半腱肌腱解剖重建距腓前韌帶及跟腓韌帶治療踝關(guān)節(jié)外側(cè)不穩(wěn)的臨床研究[J];中國現(xiàn)代醫(yī)生;2013年13期

5 華英匯;陳世益;;慢性踝關(guān)節(jié)不穩(wěn)定的外科治療進(jìn)展[J];中國醫(yī)學(xué)前沿雜志(電子版);2013年03期

6 ;[J];;年期

相關(guān)會議論文 前1條

1 劉穎;鄭卓肇;;MRI上不同角度對正常踝關(guān)節(jié)距腓前韌帶及跟腓韌帶顯示效果分析[A];中華醫(yī)學(xué)會第十八次全國放射學(xué)學(xué)術(shù)會議論文匯編[C];2011年

，

本文編號：2161192