自体半腱肌肌腱微创重建踝关节外侧韧带的中期随访研究

目的观察应用自体半腱肌肌腱微创重建踝关节外侧韧带的长期临床疗效。方法回顾性分析2006年9月至2012年6月采用自体半腱肌肌腱微创手术治疗慢性踝关节外侧不稳的58例患者资料,其中男34例,女24例,平均年龄32.4岁（17~62岁）。踝关节初次扭伤至接受手术的时间6~38月,平均17.3个月。本组患者均由同一手术组医师采用相同的微创手术方法,重建距腓前韧带及跟腓韧带。记录患者的手术时间、发热天数、伤口愈合时间。患者术前术后均按照美国足踝外科协会（AOFAS）踝关节评分标准,VAS评分分别评估手术前后疗效、供区功能影响状况和患者满意度。结果本组患者手术时间75~98 min,平均（85.5±11.5）min,术后发热天数1.5~4 d,平均（2.5±1.2）d,46例获得随访。随访时间25~86个月,平均（58.5±7.4）个月。末次随访时平均AOFAS踝与后足评分,术前（62.3±8.2）分,术后（95.1±7.5）分,差异有统计学意义（P〈0.01）。6例患者行走在不平的地面上有残余的不稳定。3例患者平地行走仍有残余不稳定。所有患者无膝部肌腱供区功能障碍。术后AOFAS评分31例患者为优,9例为良。术后应力位摄片距骨倾斜角平均由14°减少到3.7°（P〈0.01）,距骨前移距离平均由12.4 mm减少到4.5 mm（P〈0.01）。结论使用自体半腱肌肌腱微创重建踝关节外侧韧带手术简便,手术时间短,术后发热时间短,无排斥反应。自体肌腱愈合康复过程快,手术疗效好。

Mid-term follow-up study of minimally invasive reconstruction of ankle joint lateral ligament with autologous semitendinosus tendon

Objective To assess the results of a minimally invasive method for reconstructing the lateral ligaments of the ankle using a semitendinosus tendon autograft. Methods From September 2006 to June 2012, 58 patients （34 males, 24 females） with chronic ankle instability underwent the lateral ligament reconstruction by a minimally invasive method with the semitendinosus autograft. The average age was 58.5 （range, 17 to 62 ） years old. The semitendinosus tendon was harvested through two small incisions at the knee. For the ankle reconstruction, four small incisions of 5 mm each were made at the medial and lateral sides of the fibular tip, the talar neck, and the middle of the ealcaneus. The anatomical reconstructions of the anterior talofibular ligament （ATFL） and the calcaneofibular ligament （CFL） were then performed through these small incisions. The mean follow-up time was （58.5 ± 7.4） months, （ range, 25 to 86 months）. AOFAS, VAS questionnaires were used to evaluate the clinical outcomes, donor site morbidity and the patient satisfaction. The preoperative and postoperative stress tests were performed and the radiographic parameters were measured. Results The average opereation time of the autograft group was 75-98 min, （85.5 ± 11.5） min in average, and the lasting time of the postoperative fever were 1.5 -4 days, （2. 5 ± 1.2） days in average. In the autograft group, 46 patient were followed up, the follow-up time ranged from 25 to 86 months, （58.5 ± 7.4） months in average. The average AOFAS score increased from （62. 3 ± 8.2） to （95. 1 ± 7. 5 ） （ P 〈 0. 01 ）. Six patients reported the residual instability on the uneven ground. Three patients of the autologous group reported the instability in daily life. No patient reported weakness or disability in the donor site. The satisfaction level of the autograft group was excellent in 31 patients and good in nine patients. Significant improvemertt of the talar tik angle according to the stress radiographic parameters wa