锚钉固定缝合治疗三角韧带陈旧性损伤

 目的 探讨锚钉固定重叠缝合治疗三角韧带陈旧性损伤的疗效。方法 回顾性分析2007年1月至2011年12月，治疗17例三角韧带陈旧性损伤患者资料，男11例，女6例；年龄18～58岁，平均32.1岁；均有踝关节扭伤史，病程为7～25个月，平均14.2个月。患者术前均行踝关节负重正、侧位X线片、双足正、斜位X线片、MRI及B超检查。确诊为内侧三角韧带损伤后，患肢行踝关节镜检查再次明确诊断并清理关节内增生的滑膜及合并损伤的关节软骨。切开踝关节内侧间隙，清理韧带残端瘢痕组织，其中2例同时清理陈旧性内踝尖撕脱骨折片。将三角韧带深层断端缝合于内踝尖，三角韧带浅层重叠缝合于内踝骨膜，使用锚钉固定。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝与后足评分评价手术前后踝关节。结果 17例患者均获得随访，随访时间12～34个月，平均20.1个月。影像学与术中检查均发现三角韧带损伤且已瘢痕化。距骨-第一跖骨角及Saltzman位后足力线角分别从术前5.4°±1.8°和8.2°±2.6°降至术后4.0°±0.9°和5.3°±1.3°。AOFAS踝与后足评分，术前为平均(76.8±7.0)分 ，末次随访时为平均(94.1±3.3)分；其中优10例，良6例，可1例，优良率为94.1%(16/17)。17例患者疼痛均有效缓解。末次随访时，无一例患者出现三角韧带再损伤。结论 锚钉固定缝合治疗三角韧带陈旧性损伤可以获得良好的效果。

Treatment of deltoid chronic injury induced flatfoot deformity using TwinFix

Objective To explore the effect of the treatment for the old deltoid ligament injuries by TwinFix suture anchors fixation along with overlap suturing. Methods Totally the data of 17 patients with old deltoid ligament injury was retrospectively reviewed who received treatment from January 2007 to December 2011. There were 11 males and 5 females, with an average age of 32.1 years (range, 18-58 years). All of them had ankle sprain histories with the duration ranging from 7-25 months (average, 14.2 months). All patients received weight-bearing X-ray, bilateral anterior-posterior (AP) and oblique radiography, MRI and ultrasound examinations before operation. Further arthroscopic examination was performed to confirm the diagnosis and debrided the intra-articular proliferative synovial tissue as well as injured articular cartilage for the patients after they were diagnosed with deltoid ligament injury. Open surgeries were performed though an incision on the medial ankle space. Residual ligament and scar tissue were cleaned. Old avulsion fractures of medial ankle tip were removed in 2 cases. The deep layer of ruptured deltoid ligament was sutured onto the tip of medial malleolus while the superficial layer was overlapped and sutured to the periosteum of medial ankle. Anchors were then utilized to fix the ligament. The clinical outcomes were evaluated based on American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. Results The follow-up duration of the 17 patients were 12-34 months with an average of 20.1 months. Both image evidences and intraoperative findings revealed the injury and scarring of deltoid ligament. The angle between long axis of talus and first metatarsal and the angle of hindfoot alignment in Saltzman view reduced from 5.4°±1.8°, 8.2°±2.6° before surgery to 4.0°±0.9° and 5.3°±1.3° after surgery respectively. The mean AOFAS hindfoot score before operation was 76.8±7.0 and increased to 94.1±3.3 at the last follow-up. There were ten cases receiving excellent effect, 6 good and 1 moderate. The good and excellent rate was 94.1%(16/17). All the 17 patients achieved pain relief and none had recurrent injury till the last follow-up. Conclusion TwinFix suture anchor fixation along with overlap suturing was an effective way in dealing with old deltoid ligament injury cases.