腓骨短肌腱转位修复踝关节外侧副韧带损伤及踝关节不稳的临床疗效观察

The clinical observation for the effect of the peroneus brevis tendon transposition to repair the injury of lateral ligament of ankle instability

目的探讨腓骨短肌腱转位修复踝关节外侧副韧带损伤及踝关节不稳的有效性。方法回顾性分析2007年7月-2013年12月收治的116例踝关节外侧副韧带损伤患者的资料．所有患者均行腓骨短肌腱转位、强生带线锚钉固定术以重建踝关节外侧副韧带，术后患者踝关节用石膏托固定于伸屈中立位，并保证轻度外翻，观察患者近期和远期疗效。结果共计随访116例，随访时间为9个月-5．5年，平均2．8年。本组患者手术切口均一期愈合；患足局部无肿痛，行走正常，踝关节主动活动及被动活动均良好；患足前抽屉试验阳性率仅为1．7％：术后触压痛和活动痛的视觉疼痛评价法（VAS）评分及关节活动度（ROM）评价指标与术前相比，经t检验统计学分析，差异具有显著性（P〈0．05）；术前美国足与踝关节协会（AOFAS）评分为（41．81±3．21）分，术后为（88．21±2．53）分。上述结果经t检验统计学分析，差异具有显著性（P〈0．05）。结论（1）踝关节外侧副韧带损伤是导致慢性踝关节不稳．甚至踝关节骨性关节炎的常见原因；（2）腓骨短肌腱转位、带线锚钉固定法是治疗踝关节外侧副韧带损伤的有效且简便的方法，对于治疗踝关节不稳、防止踝关节骨性关节炎的发生具有重要作用。

Objective To investigate the peroneus brevis tendon transposition for repairment of ankle lateral ligament damage and instability of the ankle joint. Methods A retrospective analysis from 2007 July to 2013 December treated 116 patients with ankle joint lateral collateral ligament injury data, all patients underwent peroneus brevis tendon transposition, Johnson strip anchor fixation with reconstruction of the lateral ligament of ankle joint, ankle postoperative patients with plaster fixation in flexion and neutral a mild valgus, and guarantee, and the patients were observed the effects of short-term and long-term. This group included 51 male patients, 65 female patients; age ranges from 16 to 61 years old, average 38.5 years old. Results A total of 116 patients were followed up, follow up time was 9 months to 5.5 years, average 2 years and 8 months. All patients were stage I operation incision healing; and the risk of foot and no local swelling and pain, walking normal, ankle active and passive activities are good, good ankle active and passive activities; the positive rate of foot from the anterior drawer test is only 1.7%; visual assessment of pain tenderness and pain after operation （VAS） score and range of motion （1KOM） compared with the preoperative evaluation, analysis by T test statistics, with significant difference （P 〈 0.05）; preoperative USA foot ＆ Ankle Society （AOFAS） score （41.81 ＋3.21）, postoperative （88.21＋2.53）, the results by T test statistical analysis, with a significant difference （P 〈 0.05）. Conclusion （1） ankle lateral ligament injury isthe result of chronic ankle even ankle osteoarthritis; instability, common cause （2） peroneus brevis tendon transposition, the belt line anchor fixing method is effective and simple treatment of ankle joint lateral collateral ligament injury, for the treatment of ankle instability to prevent the occurrence, plays an important role in osteoarthritis of the ankle.