慢性踝关节外侧不稳定的治疗

目的 回顾慢性踝关节外侧不稳定的治疗,对其结果进行分析和评价.方法 74例患者,其中男43例,女31例;年龄15～63岁,平均39岁.患者至少有半年以上的病史,有两次以上的反复扭伤史.所有患者均行6周以上的保守治疗.41例患者行手术治疗,改良的Brostrom术12例,Myerson法8例,Chrisman-Snook法21例.对其他并发的病理问题需同时处:其中腓骨肌腱滑脱加固术6例,跟腱挛缩延长术9例,跟内翻截骨外移术8例,距骨骨软骨损伤清理打孔13例.结果 本组74例患者,通过术前的保守治疗,21例功能性不稳定的患者症状缓解,53例合并功能性不稳定和机械性不稳定的患者中,10例症状缓解,2例不愿意手术治疗,41例行手术治疗.手术治疗的患者在术后的随访中,有随访资料的39例;33例未手术的患者中,有随访资料的28例.共随访6～91个月,采用Roos功能结果评分法进行结果评判.术后踝关节功能评分的平均值为86.24,保守治疗的患者踝关节功能评分的平均值为97.34.结论 本组74例患者,通过术前的保守治疗,21例功能性不稳定的患者症状缓解,53例合并功能性不稳定和机械性不稳定的患者中,10例症状缓解,2例不愿意手术治疗,41例行手术治疗.手术治疗的患者在术后的随访中,有随访资料的39例;33例未手术的患者中,有随访资料的28例.共随访6～91个月,采用Roos功能结果评分法进行结果评判.术后踝关节功能评分的平均值为86.24,保守治疗的患者踝关节功能评分的平均值为97.34.

Management of chronic lateral ankle instability

Objective To retrospectively analyze management of chronic lateral ankle instability and evaluate its clinical results. Methods There were 74 patients including 43 males and 31 females at age range of 15-63 years (mean 39 years). All patients had at least half year of disease history, more than twice repeated strains and over six weeks of conservative management. Of all, 41 patients were trea-ted with surgical operations including modified Brostrom in 12 patients, Myerson in eight and Chrisman-Snook in 21. The aasoeiated pathological problems should be treated at the same time, ie, tenedesis for the peroneal tendon subluxations in six patients, Achilles tendon lengthening in nine, lateral shift of cal-caneal osteotomies in eight and clearance and holes-making for the osteochondral lesions in 13. Results Of all, functional instability was alleviated in 21 patients through conservative treatment before surgery. Of 53 patients with either functional or mechanical instability, 10 patients showed symptomatic relief, two refused surgical operation and the remained 41 patients were treated surgically. Thirty-nine patients trea-ted surgically and 28 treated conservatively were followed up for 6-91 months. The Roos Functional Out-come Score was used for validating the results. The average value of the ankle functional outcome was 86.24 and 97.34 respectively following operation and conservative management. Conclusions The full examination is needed to remove any possible pathological factors for the patients with chronic lateral ankle instability. The surgical operation can obtain satisfactory functional recovery of the ankle if the conserva-tive management is failed.