同种异体肌腱解剖重建修复慢性踝关节外侧不稳

Anatomic reconstruction of lateral ligament with tendon aUograft for chronic lateral ankle instability

目的观察应用同种异体肌腱解剖重建修复慢性踝关节外侧不稳（CLAI）的效果。方法回顾性分析2013年1月至2014年1月采用同种异体肌腱治疗的30例CLAI患者资料，男12例，女18例；年龄23～45岁，平均35．3岁。比较术前和术后末次随访时美国足踝外科协会（AOFAS）的踝-后足评分、Karlsson-Peterson评分、Seflon关节稳定性分级及距骨前移距离、距骨倾斜角度。结果术后26例患者获平均20．3个月（15～27个月）的随访。术后6周复查均能非负重行走，术后12周能负重行走，X线片下应力踝关节内翻试验及前抽屉试验均阴性，末次随访时所有患者均恢复正常生活，未诉明显不适。末次随访时的AOFAS踝-后足评分（87．1±4．9）分、Karlsson-Peterson评分（89．6±4．5）分、Sefton关节稳定性分级（2级）、距骨前移距离（3．5±0．4）mm、距骨倾斜角度3．9°±0．9°均较术前[（56．3±11．0）分、（51．1±7．5）分、4级、（7．6±0．8）mm、14．3°±2．2°]改善，差异有统计学意义（P〈0．05）。患者满意度评价：极好15踝，良好6踝，差5踝，满意度为80．8％。结论应用同种异体肌腱解剖重建CLAI安全可靠，疗效显著。

Objective To observe the efficacy of tendon allograft reconstruction of chronic lateral ankle instability （CLAI）. Methods We retrospectively reviewed the 30 CLAI patients who had received tendon allograft reconstruction of lateral ligament between January 2013 and January 2014. They were 12 men and 18 women, aged from 23 to 45 years （average, 35.3 years）. Their American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot score, Karlsson-Peterson score, Sefton articular stability scale, anterior talar translation and talar tilt angle were compared between preoperation and the last follow-up. Results Of this series, 26 cases （26 ankles） were followed up for an average period of 20.3 months （from 15 to 27 months）. Follow-up at 6 weeks after surgery showed they could complete non-weight-bearing walking and follow-up at 12 weeks observed that they achieved weight-bearing walking. X-ray films showed negative results of stress ankle varus test and anterior drawer test. At the last follow-up, all patients recovered normal life without obvious discomfort. Their AOFAS ankle and hindfoot score （87. 1 ±4. 9）, Karlsson-Peterson score （89.6 ±4.5）, Sefton articular stability scale （gradeⅡ）, anterior talar translation （3.5 ±0. 4 mm） and talar tilt angle （3.9° ± 0.9°） at the last follow-up were significantly improved in comparison with the preoperative values （56.3± 11.0, 51.1 ±7.5, grade IV, 7.6 ±0.8mm, 14.3°±2.2°, respectively） （P 〈 0.05）. The follow-up showed 15 excellent, 6 good and 5 poor ankles, yielding a patient satisfaction rate of 80.8%. Conclusions Anatomic reconstruction with tendon allograft is safe and effective for chronic lateral ankle instability.