踝关节外侧不稳定关节镜下表现与稳定重建的临床研究

A Clinical Research on Arthroscopic Characteristics of and Reconstruction for Ankle Lateral Instability

目的探讨异体肌腱重建治疗踝外侧不稳定的临床效果,总结踝关节外侧不稳定关节内病变特征。方法对2006年7月-2013年10月踝关节外侧不稳定患者36例进行手术治疗,关节镜下观察到踝关节滑膜炎16例,游离体5例,滑膜嵌顿15例,距骨软骨损伤9例,胫骨前缘骨赘增生5例,采用滑膜清理、游离体取出、骨赘磨除、软骨下骨微骨折术等对症处理,异体肌腱结合Femoral INTRAFIX技术固定重建外侧稳定结构。术后管型石膏固定踝关节3周,同时实施康复计划。结果术后随访15-96个月,平均38个月,32例踝关节前抽屉试验阴性,4例从强阳性转为弱阳性。反复扭伤现象消失,均恢复工作和运动。AOFAS评分从术前的（36.7±0.9）分提高到术后末次随访时的（85.4±1.6）分（t=52.361,P=0.000）。术后MRI显示：外侧副韧带未见异常信号,8例韧带信号稍增粗;胫骨前缘骨赘增生消失4例;未见关节内游离体和异常滑膜信号。结论异体肌腱、Femoral INTRAFIX重建踝关节外侧副韧带临床效果肯定。重视关节内病变并及时微创处理对术后临床症状改善有重要作用。

Objective To explore the clinical effect of reconstruction with allograft tendon for ankle lateral instability and to investigate arthroscopic characteristics of ankle joint. Methods A total of 36 patients with ankle lateral instability from July 2006 to October 2013 were detected with arthroscopy. There were 16 cases of synovitis, 5 cases of loose bodies, 15 cases of synovialinterposing,9 cases of talus cartilage injury and 5 cases of anterior tibia osteophyma. Arthroscopic procedures were performed by gouging synovial membrane,dislodging loose bodies,stripping osteophyma and applying microfracture. The lateral ligaments were reconstructed by allogeneic tendon and fixed by using Femoral INTRAFIX technique. Postoperatively the ankle was fixed with cast for 3weeks. The rehabilitation program was performed at the same time. Results The patients were followed up for 15- 96 months,with38 months averagely. Stability of lateral ankle in all the patients was significantly improved（ anterior drawer test of the ankle showed negative in 32 patients and changed from strong positive to weakly positive in 4 patients）. The recurrent sprain disappeared in all the patients,who returned to their work and sports. The AOFAS scores were increased from（ 36. 7 ± 0. 9） points preoperatively to（ 85. 4 ± 1. 6） points at the latest follow-up time（ t = 52. 361,P = 0. 000）. The MRI after surgery showed no abnormal signal of the lateral collateral ligament in all the patients with mild thick signal in 8 patients,disappearing of anterior tibia osteophyma in 4 patients,and no loose body or abnormal synovial. Conclusions Reconstruction of lateral instability of the ankle with allograft tendon and fixation with Femoral INTRAFIX technique have satisfactory results. In order to improve symptoms and ankle functions,it is important to pay more attention to ankle joint disorders and give treatment timely with mini-invasive surgical technique.