踝关节镜下自体腓骨长肌腱解剖重建距腓前韧带治疗踝关节外侧不稳的临床研究

Clinical study of anatomical reconstruction of the anterior tibiofibular ligament in treatment of lateral ankle instability with ankle arthrodesis

目的探讨踝关节镜下自体腓骨长肌肌腱解剖重建距腓前韧带(ATFL)治疗慢性踝关节不稳的手术方法及临床疗效。方法回顾性分析2012年12月-2017年1月利用自体腓骨长肌肌腱在踝关节镜下治疗的32例踝关节外侧韧带损伤患者。采用美国足踝外科学会(AOFAS)评分标准、Tegner运动水平评分及距骨倾斜角变化对手术前后疗效进行评价,随访观察并发症发生情况。结果 32例均获得12~36个月随访,平均(26.00±6.65)个月。随访期间,所有患者踝关节活动度基本恢复正常,至末次随访时未观察到踝关节不稳定现象,踝关节肿胀、疼痛均消失,查体跖屈内翻应力试验(-)、抽屉试验(-)。末次随访时,AOFAS评分为(92.00±3.84)分、Tegner评分为(6.03±1.15)分较术前明显提高,距骨倾斜角(4.61±1.09)°较术前降低,差异均有统计学意义(P<0.05)。结论踝关节镜下自体腓骨长肌肌腱解剖重建ATFL治疗踝关节外侧不稳,镜下能更精准地探查韧带残端,定位韧带附着点,原位解剖重建ATFL,疗效理想。

Objective To investigate the surgical method and clinical efficacy of the anatomic reconstruction of the anterior talofibular ligament(ATFL)with autologous peroneal long muscle tendon under ankle arthroscopy.Methods From December 2012 to January 2017,32 patients with lateral ankle ligament injury were treated with autologous peroneal long muscle tendon under the ankle arthroscope.The American Foot and Ankle Surgery Society score(AOFAS),Tegner exercise level score and talus tilt angle change were used to evaluate the curative effect before and after operation,followed up to observe the occurrence of complications.Result All the 32 patients were followed up for 12 to 36(26.00±6.55)months.During the follow-up period,ankle activity was basically restored to normal in all of them,and ankle instability was not observed at the last follow-up.Ankle swelling and pain disappeared.Stress test of metatarsal varus(-)and drawer test(-).At the last follow-up,the AOFAS score was(92.00±3.84)and the Tegner score was(6.03±1.15),which was significantly higher than the preoperative improvement and the talus inclination angle(4.61±1.09)°,and the difference was statistically significant(P<0.05).Conclusion Anatomical reconstruction of ATFL with tendon of long peroneal muscle under ankle arthroscopy for the treatment of lateral instability of ankle joint.Ankle arthroscopy can detect ligament stump more accurately,locate ligament attachment points,and reconstruct ATFL in situ.The effect is ideal.