小切口解剖重建踝关节外侧韧带复合体治疗慢性外踝不稳的临床疗效

目的:探讨解剖重建踝关节外侧韧带复合体治疗慢性外踝不稳的临床疗效。方法:自2005年9月至2010年3月,采用解剖重建距腓前韧带及跟腓韧带手术治疗慢性外踝不稳29例,男24例,女5例;年龄15～35岁,平均24岁;病史7个月～10年,平均10个月。主要临床表现为踝关节反复扭伤。查体时29例均有踝关节的内翻增加以及距骨前移增加,内翻活动度比健侧平均增加(12.5±3.2)°。术中先在踝关节镜下处理关节内病变。移植物为自体股薄肌腱,距骨止点以锚钉在骨表面固定,移植物通过腓骨远端的骨隧道,跟骨止点以挤压钉在骨隧道内固定。术后通过观察患者症状的变化、距骨内翻和前移的程度改变以及影像学变化来评价疗效,并以AOFAS后足功能评分评价踝关节功能。结果:所有患者手术成功,无骨折及感染发生。所有患者获得随访,时间16～60个月,平均28个月。终末随访时无踝关节不稳定或活动受限。术后踝关节内翻角度比对侧增加值为(2.5±0.8)°,低于术前(t=12.3,P=0.012);距骨前移距离(3.5±0.8)mm,较术前(16.3±4.0)mm下降(t=18.6,P=0.002);距骨倾斜角(4.5±1.0)°,较术前(17.5±3.6)°下降(t=9.7,P=0.035);AOFAS后足功能评分(92.8±6.2)分,较术前(48.0±6.7)分升高(t=25.3,P=0.001)。所有患者无严重并发症出现,对疗效满意。结论:自体股薄肌腱移植解剖重建踝关节外侧韧带复合体的手术方式符合解剖学重建理念,手术创伤小,术后恢复快,无严重并发症。该手术临床效果可靠,术后踝关节稳定性恢复良好,踝关节功能明显改善。

Clinical results of anatomical reconstruction of the lateral ligaments for chronic ankle instability

Objective:To investigate the clinical and radiological results of lateral stabilization with reconstruction of the lateral ligaments for the treatment of chronic lateral instability of the ankle. Methods:From September 2005 to March 2010,29 patients with chronic lateral instability of the ankle were reviewed. There were 24 males and 5 females with an average age of 24 years(15 to 35 years). The duration of the disease ranged from 7 to 10 years,averaged 10 months. The main symptom was repeated ankle sprain. During physical examination,ankle varus and the anterior talar transition were conducted. There was (12.5±3.2)° more inversion activity than the contralateral ankle. Arthroscopy was performed for the chondral injury,and anatomic reconstruction of the lateral ligament with an autologous gracilis tendon graft was performed for lateral instability of the ankle. Clinical and radiological evaluations were performed before surgery and at the most recent follow-up. Results:All the patients with successful surgery,there was no fracture or infection. All the patients were followed up,and the duration ranged from 16 to 60 months,with an average of 28 months. There was no ankle instability or limited mobility of the 29 cases at the latest follow-up. According to the American Orthopedic Foot and Ankle Society ankle-hind foot scale,the mean score was 48.0±6.7 before surgery and 92.8±6.2 at the most recent follow-up (P=0.010). The talar tilt angles on standard stress radiography were (12.5±3.2)° before surgery and (2.5±0.8)° at the most recent follow-up (P=0.012). The mean distance of anterior talar translation was (16.3±4.0) mm before surgery and (3.5±0.8) mm at the most recent follow-up (P=0.002). There were no severe complications,the results were satisfactory. Conclusion:Anatomical reconstruction of the lateral ligament with autologous gracilis tendon graft for the treatment of chronic lateral instability of the ankle can be recommended.