半腱肌腱联合锚钉重建外侧副韧带治疗慢性踝关节不稳的临床观察

Anatomical reconstruction of the lateral ligaments with a semitendinosus autograft and anchoring system in chronic ankle instability

[目的]探讨半腱肌腱联合锚钉重建外侧副韧带治疗慢性外踝不稳的临床疗效。[方法]自2009年1月～2011年12月,采用半腱肌腱联合锚钉重建外侧副韧带治疗慢性外踝不稳23例,男10例、女13例,年龄19～47岁,平均31.5岁。主要症状为踝关节疼痛、肿胀及反复扭伤,查体踝关节内翻试验阳性、前抽屉试验阳性,应力位X线片示距骨倾斜角增大,平均(18.6±5.3)°,美国足踝外科功能评分平均(46.5±7.8)分。手术先采用关节镜处理关节腔内病变,取自体半腱肌腱作为移植物,联合锚钉重建外侧副韧带治疗慢性踝关节不稳定。术后随访观察评估患者症状体征变化、应力位距骨倾斜角及踝关节功能变化。[结果]本组病例均手术成功,无感染、骨折及神经损伤等并发症。所有患者均获得随访,时间(13～29)个月,平均(19.5±3.7)个月。终末随访时患者踝关节无疼痛、肿痛及复发不稳。查体踝关节内翻试验阴性、前抽屉试验阴性,应力位X线片示距骨倾斜角较术前明显变小,平均(4.7±1.2)°(P<0.01),美国足踝外科功能评分较术前明显改善,平均(91.2±5.8)分(P<0.01)。[结论]采用半腱肌腱联合锚钉重建外侧副韧带治疗慢性踝关节不稳定安全、可靠,能够有效改善踝关节功能。

[ Objective ] To study the clinical results of tanatomical reconstruction of the lateral ligaments with a semitendi-nosus autograft and anchoring system in chronic ankle instability. [ Method] From January 2009 to December 2011,23 patients with chronic ankle instability were treated with the anatomical reconstruction of a semitendinosus autograft and anchoring sys- tem. This group consisted of 10 males and 13 females with an average age of 31.5 years old （range from 19 to 47 years old）. The symptom mainly included pain, swelling and recurrent sprain of the ankle. The positive findings were observed in varus stress test and anterior drawer test in physical examination. Preoperatively, the talar tilt angle was a mean of （ 18.6 ± 5.3 ）° un-der stress radiography. The average scores of American Orthopaedic Foot and Ankle Society （AOFAS） was （46.5 ± 7.8 ） points preoperatively. In this group, the lesions in joint cavity were treated arthroseopically, and then the ankle instability was treated with anatomical reconstruction of a semitendinosus autograft and anchoring system. The clinical results, talar tilt angle and AO- FAS scores were followed up postoperatively. [ Result] All patients were operated successfully and there were no complications of infection,fracture,and nerve injury. The patients were followed up with an average duration of （ 19.5 ± 3.7 ） months （ range from 13 to 29 months）. At the final follow - up, the treated ankles were found no pain, swelling and recurrent instability. The negative results were found in the physical examination of varus stress test and anterior drawer test. The taler tilt angle was sig- nifically reduced to a mean of （4.7 ± 1.2）° as compared to the preoperative （P 〈 0.01 ）. The score of AOFAS was also im- proved to an average of （91.2 ± 5.8 ） points, which was significantly higher than that of the preoperative （ P 〈 0.01 ）. [ Conclu-sion] Anatomical reconstruction of the lateral ligament with a semitendinosus autograft and anchoring system is a reliable and satisfactory treatment for chronic ankle instability, which could significantly improve the function of the ankle.