三角韧带解剖重建并跟骨内移截骨治疗创伤后慢性踝关节内侧不稳的疗效分析

Anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy for treatment of post-traumatic chronic medial ankle instability

目的探讨采用三角韧带解剖重建并跟骨内移截骨治疗创伤后慢性踝关节内侧不稳的疗效。方法回顾性分析2015年12月至2017年2月佛山市中医院骨八科治疗的16例创伤后慢性踝关节内侧不稳患者资料。男14例,女2例;年龄为(28.1±4.2)岁;左侧7例,右侧9例;受伤至手术时间为(8.9±2.4)个月。术前摄负重位X线片(踝关节正侧位、saltzman位)和踝关节MRI;术中均采用自体半腱肌肌腱解剖重建三角韧带及跟骨内移截骨治疗。记录损伤愈合时间及并发症发生情况,比较患者术前与末次随访时的距骨倾斜角、Meary角、后足外翻角、疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)的踝-后足功能评分。采用Sefton踝关节韧带重建评价标准评估踝关节稳定性。结果14例患者术后获(16.4±4.9)个月随访。14例患者均于术后3个月恢复正常体育活动。患者切口均Ⅰ期愈合,无感染发生,1例患者出现取半腱肌处疼痛,经按摩、理疗等康复治疗后症状缓解。末次随访时距骨倾斜角[1.0(0.0,2.0)°]、Meary角(1.4°±4.2°)、后足外翻角(3.2°±2.4°)、VAS评分[0.5(0.0,1.0)分]、AOFAS的踝-后足评分[(89.2±6.1)分]均较术前[8.3°±1.8°、0.8°±3.8°、9.9°±3.4°、(5.7±2.5)分、(49.6±9.8)分]显著改善,差异均有统计学意义(P<0.05)。末次随访时根据Sefton评价标准:优9例,良4例,可1例。结论三角韧带解剖重建并跟骨内移截骨是治疗创伤后慢性踝关节内侧不稳的短期安全、有效的方法,且并发症较少。

Objective To evaluate the clinical effects of anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy in the treatment of chronic ankle instability after trauma.Methods A retrospective study was conducted to analyze of the clinical data of 16 patients with chronic post-traumatic instability of the medial malleolus who had been treated at The Eighth Department of Orthopedics,Foshan Hospital of Traditional Chinese Medicine from December 2015 to February 2017.There were 14 males and 2 females with an age of(28.1±4.2)years.Seven left sides and 9 right sides were affected;the time from injury to operation was(8.9±2.4)months.Before operation,X-rays(anteroposterior,lateral and Saltzman views)and MRI of weight-bearing ankle were taken.All patients were treated by anatomical reconstruction of the deltoid ligament using the autologous semitendinosus and medial migration osteotomy of the calcaneus.The time for injury healing and occurrence of complications were recorded.The talus tilt angle,Meary angle,hindfoot valgus angle,visual analogue scale(VAS),and the American Orthopedic Foot&Ankle Society(AOFAS)ankle-hindfoot function score were compared between the preoperation and the last follow-up.The Sefton evaluation for efficacy in ankle ligament reconstruction was used to assess stability of the ankle joint.Results Of this cohort,14 patients were followed up for(16.4±4.9)months after operation and 2 patients lost to follow-up.The 14 patients all returned to normal physical activities 3 months after operation.All incisions healed at the first stage with no infection.One patient experienced pain at the site for harvest of the semitendinosus but the symptoms were relieved after rehabilitation treatment like massage and physical therapy.At the last follow-up,the talus tilt angle[1.0(0.0,2.0)°],Meary angle(1.4°±4.2°),hindfoot valgus angle(3.2°±2.4°),VAS score[0.5(0.0,1.0)points],and AOFAS ankle-hindfoot score[(89.2±6.1)points]were all significantly improved compared with the preoperative values[8.3°±1.8°,0.8°±3.8°,9.9°±3.4°,(5.7±2.5)points,and(49.6±9.8)points](all P<0.05).According to the Sefton evaluation,the stability of the ankle joint was excellent in 9 cases,good in 4 cases,and fair in 1 case.Conclusion In the treatment of chronic ankle instability after trauma,anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy is safe and effective,resulting in limited complications.