预牵张在异体肌腱微创移植重建踝关节外侧韧带中的疗效

Effect of Pre-stretching on Reconstruction of Lateral Ligament of Ankle Using Minimally Invasive Allogenic Tendon

目的:比较预牵张与否在异体肌腱微创移植重建踝关节外侧韧带的疗效差异。方法:2012年12月至2014年11月,对41例踝关节不稳患者,采用同种异体肌腱微创移植重建踝关节外侧韧带手术治疗,根据术中异体肌腱预牵张与否分成两组:预牵张组(n=21)和未预牵张组(n=20)。两组均行异体肌腱微创移植重建踝关节外侧韧带,预牵张组将异体肌腱编织后置于肌腱牵张器上以80 N预牵张10 min后再行移植,未牵张组将异体肌腱编织后直接移植。术后均给予相同的康复训练。比较两组患者的手术时间、发热情况、伤口愈合时间、距骨倾斜角、距骨前移距离,患者术前术后AOFAS评分、VAS评分。结果:预牵张组的手术时间稍长于未预牵张组但无显著性差异,发热和伤口愈合时间与未预牵张组无明显差异,两组术后末次随访时的AOFAS评分、VAS评分、距骨倾斜角及距骨前移距离均较术前显著改善(P<0.01),组间无显著差异;随访结束后,预牵张组疗效优良率为90.47%,与未牵张组90.00%比较无显著差异。结论:在踝关节外侧韧带解剖重建术时,对移植肌腱进行预牵张并不必须,牵张与否早中期的疗效无显著差异。

Objective To explore the effect of pre-stretching on the reconstruction of the lateral liga-ment of the ankle using minimally invasive allogenic tendons. Method Forty-one ankle instability pa-tients to undergo allogenic tendon minimally invasive reconstruction of lateral ligament ankle surgeryfrom December 2012 to November 2014,were randomly divided into two groups according to whetherthe allografts were pre-stretched： a pre-distraction group（n = 21） and a non-pre-distraction group（n=20）. In the pre- stretching group,allografts were woven,placed on the tendon distractor and pre-stretched with 80 N for 10 min before transplantation. In the non-stretching group,allografts were wo-ven and transplanted directly. The same rehabilitation training was given to both groups after operation.Patients＇ data were recorded,such as the operation duration,the temperature,wound healing time,the ta-lus tilt angle and the anterior talar displacement. They were also evaluated using AOFAS scores andVAS scores before and after the operation. Result The operative time of the pre-distraction group wasslightly longer than that of the non-pre-distraction group. There was no significant difference in feverand wound healing time between the two groups. At the last postoperative follow-up of the two groups,the average AOFAS score and the VAS score,the talus tilt angle and the anterior talar displacementwere significantly improved compared with those before the operation（P〈0.01）,and there was no signifi-cant difference between the two groups. The excellent rate of the pre-distraction group was 90.47%,without significant difference from the other group（90.00%）. Conclusion In the anatomical reconstruc-tion of the lateral ligament ankle,the pre-stretching of the tendon is not necessary. No significant dif-ference is found whether the tendon is distracted or not.