腓骨骨膜瓣重建跟腓韧带治疗慢性踝关节不稳疗效观察

Clinical effect of calcaneofibular ligament reconstruction using fibula periosteum flap in treatment of chronic ankle instability

目的观察腓骨骨膜瓣翻转重建跟腓韧带治疗慢性踝关节不稳的临床疗效。方法回顾性分析自2012—03—2014—08采用腓骨骨膜瓣翻转重建跟腓韧带治疗慢性踝关节不稳15例。根据术前应力位X线片明确为距腓前韧带及跟腓韧带损伤，采用腓骨骨膜瓣翻转重建跟腓韧带。术后12个月进行AOFAS踝关节功能评分、前抽屉试验和内翻应力位试验，同时观察应力位X线片上距骨倾斜角的变化情况。结果15例术后均获得随访12—38个月，平均18．6个月。术后1例出现腓浅神经损伤。术后踝关节不稳、肿胀、疼痛均缓解，内固定锚钉稳固，2例踝关节背伸活动轻度受限。术前距骨倾斜角为（15．6±4．4）°，术后12个月距骨倾斜角为（7．4±2．6）°，差异有统计学意义（t=6．930，P=0．026）。术后12个月AO-FAS评分由术前（43．5±6．9）分增加至（69．8±7．1）分，差异有统计学意义（t=3．230，P=0．032）。结论腓骨骨膜瓣翻转重建跟腓韧带在慢性踝关节不稳的治疗中可取得较为满意的效果，其优势在于创伤较小，在不破坏正常肌腱的情况下达到解剖重建。

Objective To study the clinical effect of the reconstruction of the fibula periosteum flap in treatment of chronic ankle instability. Methods From March 2012 to August 2014, 15 patients with the chronic lateral ankle instability were retrospectively analyzed. The preoperative stress X-ray confirmed calcaneofibular ligament and tibiofibular ligament injuries. The fibular periosteal was used to reconstruct the calcaneofibular ligament. And postoperative follow-up were more than 12 months. All patients were followed up with AOFAS score, anterior drawer test and inversion should stress test. Simultaneously the changes of the stress X-ray talar tilt angle were observed. Results All 15 cases were followed up for 12-38 months, for an average of 18.6 months. There was 1 case of superficial pemneal nerve injury after operation. The ankle instability, swelling and pain were relieved. In 2 cases, ankle pronation was slightly limited with internal fixation. Difference between preoperative talar tilt angle （15.6±4.4）° and 12-month postoperative talar tilt angle （7.4±2.6）° was statistically significant（t = 6.930, P =0.026）. The AOFAS score was increased from 43.5±6.9 preoperatively to 69.8±7.1 at 12 months after surgery, and the difference was statistically significant （t =-3.230, P =0.032）. Conclusion The treatment of chronic ankle instability with the reconstruction of the fibula periosteum flap and the reconstruction of the fibula ligament can achieve satisfactory therapeutic results. The advantage of this surgical method is that the wound will be small and the anatomic reconstruction can be achieved without damaging the normal tendon.