自体半腱肌重建外侧副韧带治疗慢性踝关节外侧不稳的疗效分析

Treatment of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft

目的 :探讨采用自体半腱肌重建外侧副韧带治疗慢性踝关节外侧不稳的临床疗效。方法 :回顾性分析2014年9月至2016年11月采用自体半腱肌肌腱重建踝关节外侧副韧带治疗28例踝关节外侧不稳患者的临床资料,其中男20例,女8例;平均年龄28.6岁(18~47岁)。记录围术期并发症,并采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝关节评分标准评价术后功能改善情况,采用视觉模拟标尺法(Visual analogue scale,VAS)评估患者术后疼痛情况。结果 :28例患者均获得随访,时间6~28个月,平均18.2个月。围术期未出现医源性骨折及切口感染等严重手术并发症。末次随访时未出现踝关节不稳或踝关节活动受限,未出现膝部肌腱供区肌肉功能障碍。AOFAS评分由术前的53.1±6.8提高至术后的90.4±5.9,差异有统计学意义(P<0.05)。VAS评分由术前的6.3±1.7提高至术后的0.8±0.5,差异有统计学意义(P<0.05)。结论:采用自体半腱肌解剖重建踝关节外侧副韧带手术方式简便,术后恢复好,无严重并发症,临床疗效好,是治疗慢性踝关节外侧不稳的可靠方法之一。

Objective：To investigate clinical effects of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft. Methods：From September 2014 to November 2016,28 patients with chronic anterolateral ankle instability underwent lateral ligament reconstruction with semitendinosus autograft. Among them,including 20 males and 8 females with an average age of 28.6 years（18 to 47 years old）. Preoperative complications were recorded. AOFAS and VAS score were used to evaluate clinical outcomes. Results：Twenty eight patients were followed up from 6 to 28 months with an average of 18.2. No iatrogenic fracture or infection occurred. There was no ankle instability or limited at the latest follow up.AOFAS score was improved from 53.1±6.8 before operation to 90.4±5.9 at the latest follow up,and had statistical difference（P〈0.05）; while VAS score was increased from 6.3±1.7 before operation to 0.8±0.5 at the lastest follow up（P〈0.05）. Conclusion：Chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft has advantages of simple operation,good recovery,less compilations and good clinical effects. It is one of stable methods for the treatment of chronic anterolateral ankle instability.