自体韧带缝合与自体腓骨短肌腱重建治疗慢性踝关节外侧不稳的临床疗效对比

Comparison of clinical efficacy between autologous ligament suture and autogenous fibular short tendon reconstruction in treatment of lateral instability of chronic ankle joint

目的对比自体韧带缝合与自体腓骨短肌腱重建治疗慢性踝关节外侧不稳的临床疗效。方法回顾性分析自2013-05—2016-05诊治的63例慢性踝关节外侧不稳,采用自体韧带缝合(缝合组)33例,采用自体腓骨短肌腱重建(重建组)30例,比较2组手术时间、住院时间、手术前后AOFAS评分、VAS评分、距骨前移距离(ATT)和胫骨距骨角(TTA)。结果重建组手术时间和术中出血量显著高于缝合组,差异有统计学意义(P<0.05),2组并发症和住院时间比较差异无统计学意义(P>0.05),2组术前、术后1、3个月的AOFAS评分和VAS评分比较差异均无统计学意义(P>0.05),术后6个月重建组AOFAS评分显著高于缝合组,VAS评分显著低于缝合组,差异有统计学意义(P<0.05)。2组术前ATT和TTA比较差异均无统计学意义(P>0.05),术后6个月重建组ATT和TTA均显著小于缝合组,差异有统计学意义(P<0.05)。结论自体腓骨短肌腱重建治疗慢性踝关节外侧不稳能显著提高踝关节稳定性,近期临床效果优于自体韧带缝合。

Objective To compare the efficacy of autogenous ligament suture and autogenous fibular short tendonreconstruction in the treatment of lateral instability of chronic ankle joint （CLAI）. Methods Retrospective analysis wasconducted on 63 cases of chronic ankle lateral instability from May 2013 to May 2016. Thirty three cases received treatmentwith autologous ligament suture （suture group）, 30 cases with autologous fibular short tendon reconstruction（reconstructiongroup）. The two groups of surgery （A337） and tibial talus angle （TFA） were measured before and after operation, the AOFASanteroposterior function score and VAS score also were compared. Results The operation time and intraoperative blood losswere significantly higher in the reconstructed group than in the suture group, the difference was statistically significant （P 〈0.05）. There was no significant difference between the two groups in the complication and the hospitalization time （P 〉0.05）.There was no significant difference in AOFAS and VAS scores between the two groups before and 3 months （P 〉0.05）. TheAOFAS score of the reconstructed group was significantly higher than that of the suture group at 6 months after operation, the^AS score was significantly lower than that of the suture group, the difference was statistically significant（P 〈0.05）. There wasno significant difference in ATI＂ and TFA between the two groups before treatment （P 〉0.05）. ATY and TTA were significantlyless than those in the suture group at 6 months postoperatively, the difference was statistically significant （P 〈0.05）.Conclusion Autologous fibular short tendon reconstruction in the treatment of chronic ankle lateral instability cansignificantly improve the stability of the ankle. The short term clinical effect is better than autologous ligament suture.