全关节镜下距腓前韧带重建治疗慢性外踝撕脱骨折

Arthroscopic anterior talofibular ligament reconstruction for chronic avulsion fracture of lateral malleolus: surgical technique and case series

目的探讨使用全关节镜下距腓前韧带重建治疗陈旧外踝撕脱骨折的手术技巧、临床疗效及手术并发症等。方法 2013年1-11月本科对14例陈旧外踝撕脱骨折患者进行全关节镜下距腓前韧带重建,包括女性8例,男性6例,平均年龄30.5（18～40）岁。通过胫前小切口取半腱肌作为移植物。全关节镜下于腓骨侧进行骨槽制备和1枚缝合锚钉固定,距骨侧使用可吸收挤压螺钉固定。平均随访12（8～18）个月。使用AOFAS评分进行临床疗效和患者满意率的评估,并使用Telos装置对患者术前和术后的应力位片进行测量。结果平均AOFAS评分由术前（73.4±16.4）分改善至术后（95.7±6.1）分（P〈0.01）。无患者主诉术后仍有不稳定感,且无供区疼痛和肌力下降主诉。Telos装置应力位片测量由术前（11.4±3.1）mm改善至术后（2.8±0.6）mm（P〈0.01）。结论使用半腱肌进行全关节镜下距腓前韧带重建可以明显改善踝关节不稳定且无特殊手术并发症。

Objective To investigate the surgical techniques,clinical efficacy and postoperative complications of arthroscopic reconstruction for chronic avulsion fracture of lateral malleolus. Methods Clinical data of 14 ankles treated with arthroscopic anterior talofibular ligament reconstruction with autograft of semitendinosus tendon in our department from January to November 2013 were collected and retrospectively analyzed. The patients were 6 males and 8 females,with a mean age of 30. 5（ ranging from 18 to 40）.Average follow-up was 12 months（ range,8- 18 months）. The autograft of semitendinosus tendon was obtained through a small incision in the anterial tibialis. Arthroscopic interventions included preparation of bone trough in the lateral side of the fibula,fixation of a suture anchor,and fixation of bioabsorbable interference screw in the lateral side of the talus. Patients were evaluated using the American Orthopaedic Foot and Ankle Society（ AOFAS） hindfoot ankle score and Telos stress radiography. Results In the cohort,the mean AOFAS hindfoot ankle score was increased from 73. 4 ± 16. 4 preoperatively to 95. 7 ± 6. 1 at the end of follow-up（ P〈0. 01）. None of the patients complained of postoperative ankle instability,or pain or decreased muscle strength in the donor site. Mean postoperative Telos stress A-P distance was 2. 8 ± 0. 6 mm,significantly improved when compared to the mean preoperative distance of 11. 4 ± 3. 1 mm（ P〈0. 01）. Conclusion Arthroscopic ligament reconstruction for chronic avulsion fracture of lateral malleolus using semitendinosus autograft obviously improves chronic ankle instability and causes no obvious complication.