腓骨沟加深术联合肌腱转位术治疗慢性腓骨肌腱脱位

Peroneal sulcus deepening combined with tendon transposition for the treatment of chronic peroneal tendon dislocation

目的探讨腓骨沟加深术联合肌腱转位术治疗慢性腓骨肌腱脱位的手术疗效。方法回顾性分析2006年6月至2013年8月,采用腓骨沟加深术联合肌腱转位术治疗12例慢性腓骨肌腱脱位症患者资料,男9例,女3例;年龄18~34岁,平均(24.6±4.3)岁;左侧3例,右侧9例;运动损伤8例,扭伤4例;腓骨沟平坦8例,凸起4例。12例患者外踝均伴有弹响,可触及“条索状”肌腱,踝背伸外翻抗阻力试验阳性;术前弹响、疼痛症状持续时间12~23周,平均(16.9±4.0)周。术前所有患者均采用石膏固定3~4周治疗无效,故采用腓骨沟加深及腓骨长肌肌腱转位法治疗。术后采用视觉模拟评分(visual analogue scale,VAS)评估疼痛,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分评价踝关节功能,并与术前评分进行统计学分析。结果12例患者均获得随访,随访时间25~50个月,平均(37.3±7.0)个月。VAS评分和AOFAS踝-后足评分分别由术前(5.6±0.9)分和(61.4±5.6)分改善至末次随访时的(0.5±0.7)分和(92.6±4.2)分,术前和术后比较,差异均有统计学意义(t=16.250和-18.475,均P=0.000)。根据AOFAS踝-后足评分,优10例,良2例,优良率100%。患者术后恢复运动时间23~32周,平均(26.42±3.06)周。术后伤口均一期愈合,无一例发生感染、皮肤坏死、再脱位等并发症。术后3个月影像学复查证实腓骨截骨处完全愈合,骨片无移位。术后3个月,患者均可进行日常活动,6个月均可行体育运动。末次随访时,12例患者均未出现腓骨肌腱再脱位及顽固性疼痛。结论腓骨沟加深术联合腓骨长肌转位法能有效治疗慢性腓骨肌腱脱位,并取得良好疗效。

Objective To introduce a combined operation for treating chronical peroneal tendon dislocation and to evaluate the clinical outcomes of patients.Methods Data of 12 ankles in 12 patients(male 9,female 3)with chronical peroneal tendon dislocation who underwent the fibular groove deepening procedure with transposition of the peroneal longus muscle from June 2006 to August 2013 were retrospectively analyzed.The mean age was 24.6±4.3 years(range,18-34 years),and there were 3 cases on left side,9 on right side.The mechanism of peroneal tendon injury consisted of sports injuries in 8 and sprains in 4.There were 8 cases of flat fibula sulcus and 4 cases of convex.All patients met the inclusion criteria of a painful snapping or popping sensation or palpable clicking and positive provocation maneuver and without fracture and were treated with peroneal sulcus deepening and peroneal longus tendon transposition.The duration of preoperative popping and pain symptoms ranged from 12 to 23 weeks,with an average of 16.9±4.0 weeks.All cases were treated conservatively 3-4 weeks before operation and were not effective.The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale,visual anologue scale(VAS).Results Twelve patients were followed up with an average period of 37.3±7.0(range,25-50)months.The mean VAS scale score of all patients reduced from 5.6±0.9 to 0.5±0.7 at the latest follow-up.The mean AOFAS scale score improved from 61.4±5.6 to 92.6±4.2 at the latest follow-up.The difference between preoperative and postoperative was statistically significant.(t=16.250,-18.475;P=0.000).According to the evaluation of symptom and function scoring system,10 cases were excellent and 2 cases were good,with an excellent rate of 100%.The mean postoperative return-sport time was 26.42±3.06 weeks(range,23-32 weeks).All patients healed primarily and no infection,skin necrosis and residual redislocation occurred.The osteotomy healed completely without displacement,which was confirmed by imaging examination in three months postoperation.No patients had intractable pain after surgery,and they were able to perform daily activities at 3 months and physical exercise at 6 months after surgery.No slip occurred in all patients at the latest follow-up.Conclusion The fibular groove deepening procedure with transposition of the peroneal longus muscle can effectively treat chronical peroneal tendon dislocation and obtain good medium-term results.