| 单隧道悬吊固定解剖重建外侧韧带复合体治疗慢性踝关节外侧不稳 |
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投稿时间：2020-11-05
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| 作者 | Author | 单位 | Address | E-Mail |
| 石慧生 |
SHI Hui-sheng |
中国中医科学院望京医院, 北京 100102
北京中医药大学, 北京 100029 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 孙晋 |
SUN Jin |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 马佳 |
MA Jia |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 张晟 |
ZHANG Sheng |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 刘晓华 |
LIU Xiao-hua |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 姜博 |
JIANG Bo |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 李妍 |
LI Yan |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 张磊 |
ZHANG Lei |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
arthroartist@163.com |
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| 期刊信息：《中国骨伤》2021年，第34卷，第2期，第143-147页 |
| DOI：10.12200/j.issn.1003-0034.2021.02.009 |
| 基金项目: |
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中文摘要:
目的：探讨单隧道悬吊固定解剖重建外侧韧带复合体术治疗慢性踝关节外侧不稳的临床疗效。
方法：回顾性分析2016年1月至2018年12月行单隧道悬吊固定踝外侧韧带复合体解剖重建的23例慢性踝关节外侧不稳患者的临床资料，其中男7例，女16例；年龄17～33（26.0±4.3）岁；Kellgren-Lawrence（K-L）分级：0级16例，Ⅰ级7例；扭伤2～15（5.7±2.9）次；受伤至手术时间4～18（9.0±3.3）个月。记录患者术后24个月术侧和健侧踝关节活动范围，采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society，AOFAS）功能评分和视觉模拟评分（visual analogue scale，VAS）评价踝关节功能及疼痛改善情况，并采用X线K-L分级和踝关节核磁评分（MRI scoring of osteoarthritis of ankle，MSOA）评估踝关节软骨退行性改变程度。
结果：23例患者均获得随访，时间24～48（33.4±6.7）个月。所有患者行距腓前韧带和跟腓韧带单隧道悬吊固定解剖重建术。术后24个月术侧踝关节背屈、跖屈、内翻和外翻活动范围较健侧均减小，其中术侧踝关节背屈和外翻与健侧比较差异无统计学意义（P>0.05），跖屈和内翻与健侧比较差异有统计学意义（P<0.05）。AOFAS评分由术前的（55.19±6.94）分提高至术后24个月的（93.77±3.42）分（P<0.05），23例均为优。VAS评分由术前的（5.30±1.12）分降低至术后24个月的（1.10±0.81）分（P<0.05）。术后24个月K-L分级：0级14例，Ⅰ级8例，Ⅱ级1例。手术前后K-L分级比较差异无统计学意义（P>0.05）。MSOA评分由术前的（3.74±2.54）分提高至术后24个月的（7.04±2.51）分（P<0.05）。
结论：单隧道悬吊固定术式解剖重建外侧韧带复合体创造了更好的腱骨愈合条件，提高了手术安全性，并可获得满意的临床疗效。 |
| 【关键词】慢性踝关节外侧不稳 解剖重建 临床疗效 |
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| Anatomical reconstruction of lateral ligament complex with single-tunnel pullout stutrue fixation for chronic lateral ankle instability |
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ABSTRACT
Objective: To explore clinical effects of single-tunnel pullout structure fixation and anatomical reconstruction of lateral ligament complex in treating chronic lateral ankle instability
Methods: From January 2016 to December 2018,clinical data of 23 patients with chronic lateral malleolus instability who underwent anatomical reconstruction of lateral malleolus ligament complex with single-tunnel pullout structure fixation,were retrospectively studied. Among them,including 7 males and 16 females,aged from 17 to 33 years old with an avergae of(26.0±4.3) years old;16 patients classified to grage 0,and 7 patients classified to gradeⅠaccording to Kellgren-Lawrence(K-L) grading;the time of sprain ranged form 2 to 15 with an average of (5.7±2.9) times;the time from injury to operation ranged to 4 to 18 months with an average of (9.0±3.3) months. The range of movement of operative and uninjured ankle joints were measured at 24 months after opertaion,visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate ankle joint function and improvement of pain,K-L grading and MRI scoring of osteoarthritis of ankle(MSOA) were used to evaluate degree of cartilage degeneration of ankle joint.
Results: All patients were followed up from 24 to 48 months with an average of (33.4±6.7) months. All the anterior talofibular ligaments and calcaneofibular ligaments were dissected and reconstructed by single-tunnel pullout structure fixation. The range of motion of dorsiflexion,plantarflexion,varus,and valgus on the operative side of ankle joint were smaller than those on the healthy side. There were no statistically differences in dorsiflexion and eversion between operative side and healthy side of ankle joint(P>0.05),while there were statistically differences in plantarflexion and varus(P<0.05). AOFAS score improved from 55.19±6.94 before surgery to 93.77±3.42 at 24 months after operation (P<0.05),and 23 patients were all excellent. VAS score reduced from 5.30±1.12 before opertaion to 1.10±0.81 at 24 months after operation(P<0.05). Forteen patients were grade 0,8 patients were gradeⅠand 1 patient were gradeⅡaccording to K-L grading,and there were no differences between before and after operation(P>0.05). MSOA score increased from 3.74±2.54 before operation to 7.04±2.51 at 24 months after opertaion (P<0.05).
Conclusion: Treatment of chronic lateral ankle instability with reconstruction of lateral ligament complex with single-tunnel pullout structure fixation could provide better tendon and bone healing conditions,improve surgical safety and could achieve satisfactory clinical outcomes. |
| KEY WORDS Chronic lateral ankle instability Anatomical reconstruction Clinical results |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 石慧生,孙晋,马佳,张晟,刘晓华,姜博,李妍,张磊.单隧道悬吊固定解剖重建外侧韧带复合体治疗慢性踝关节外侧不稳[J].中国骨伤,2021,34(2):143~147 |
| 英文格式: | SHI Hui-sheng,SUN Jin,MA Jia,ZHANG Sheng,LIU Xiao-hua,JIANG Bo,LI Yan,ZHANG Lei.Anatomical reconstruction of lateral ligament complex with single-tunnel pullout stutrue fixation for chronic lateral ankle instability[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(2):143~147 |
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