| 自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定 |
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投稿时间：2020-11-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 刘松波 |
LIU Song-bo |
郑州市骨科医院, 河南 郑州 450000 |
Orthopedic Hospital, Zhengzhou 450000, Henan, China |
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| 李兴华 |
LI Xing-hua |
郑州市骨科医院, 河南 郑州 450000 |
Orthopedic Hospital, Zhengzhou 450000, Henan, China |
823104296@qq.com |
| 刘化文 |
LIU Hua-wen |
郑州市骨科医院, 河南 郑州 450000 |
Orthopedic Hospital, Zhengzhou 450000, Henan, China |
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| 王爱国 |
and WANG Ai-guo |
郑州市骨科医院, 河南 郑州 450000 |
Orthopedic Hospital, Zhengzhou 450000, Henan, China |
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| 期刊信息：《中国骨伤》2022年，第35卷，第2期，第172-177页 |
| DOI：10.12200/j.issn.1003-0034.2022.02.016 |
| 基金项目: |
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中文摘要:
目的：探讨自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定的临床疗效。
方法：回顾性分析2016年7月至2019年7月采用自体腓骨短肌腱解剖重建距腓前韧带和跟腓韧带治疗的42例慢性踝关节外侧不稳定患者，其中男30例，女12例；年龄25~46（37.6±12.4）岁；左足15例，右足27例；受伤至手术时间3~12（7.4±2.8）个月；14例外侧副韧带走行区有压痛，28例患者诉平地行走时有多次踝关节扭伤史。术后12个月对距骨倾斜角，视觉模拟疼痛评分（visual analogue scale，VAS）进行评估，行踝关节内翻应力和前抽屉试验检查踝关节机械稳定性；采用美国足踝外科协会（American Orhopaedic Foot and Ankle Society，AOFAS）评分标准，对踝与后足功能进行评分，并评定疗效。
结果：40例患者获得随访，时间12~48（28.3±10.0）个月，2例失访。VAS由术前的（4.50±0.93）分降低到术后12个月的（1.10±0.30）分；距骨倾斜角由术前的（12.26±1.13）°减小到术后12个月的（4.60±0.45）°；AOFAS评分由术前的（65.10±7.50）分提高到术后12个月的（84.40±3.95）分；其中优27例，良7例，可5例，差1例。术后1例患者出现腓肠神经损伤症状，口服甲钴胺3个月后症状缓解，其余患者无神经损伤、感染、皮缘坏死等并发症；未出现踝关节不稳定现象，踝关节内翻应力试验和抽屉试验均为阴性。
结论：自体腓骨短肌腱双骨道穿腱式（改良Chrisman-Snook术式）能够解剖学重建距腓前韧带和跟腓韧带，恢复患者踝关节的稳定性，术后并发症少，踝关节功能恢复良好。 |
| 【关键词】关节不稳定性 踝关节 距腓前韧带 跟腓韧带 |
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| Reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon in the treatment of chronic lateral ankle instability |
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ABSTRACT
Objective: To explore the clinical efficacy of reconstruction the anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon for the treatment of chronic lateral ankle instability.
Methods: The clinical data of 42 patients with chronic lateral ankle instability treated by anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon from July 2016 to July 2019 was retrospectively analyzed. Including 30 males and 12 females,age ranged from 25 to 46 years old with an average of (37.6±12.4) years. There were 15 cases of left foot and 27 cases of right foot,the time from injury to operation was 3 to 12 months with a mean of (7.4±2.8) months. And 14 patients had tenderness in lateral collateral ligament area,28 patients complained of multiple ankle sprains while walking on the flat ground. At 12 months after operation,the talar tilt angle and visual analogue scale(VAS)were observed,ankle joint varus stress and anterior drawer test were performed to check the mechanical stability of the ankle joint,American Orhopaedic Foot and Ankle Society(AOFAS) was used to score the ankle and hindfoot functions and evaluate the curative effect.
Results: Forty patients were followed up for 12 to 48 months with an average of (28.3±10.0) months,2 cases were lost. The VAS decreased from(4.50±0.93) scores before surgery to (1.10±0.30) scores at 12 months after surgery;the talar tilt angle was reduced from (12.26±1.13)° before operation to (4.60±0.45)° at 12 months after operation;the AOFAS score increased from (65.10±7.50)scores before surgery to (84.40±3.95) scores at 12 months after surgery;all the differences were statically significant(P<0.05). According to the AOFAS score,27 cases got excellent results,7 good,5 fair,and 1 poor. One patient had the symptoms of sural nerve injury after operation,and the symptoms were relieved after oral Mecobalamin for 3 months. The remaining patients had no complications such as nerve injury,infection,and skin necrosis. There was no instability of ankle joint,and both ankle varus stress test and drawer test were negative.
Conclusion: Autologous peroneal brevis tendon with double bone channel pass through the tendon (modified Chrisman-Snook operation) can anatomically reconstruct the anterior talofibular ligament and the calcaneofibular ligament,restore the stability of the patient's ankle joint,reduce postoperative complications,and restore ankle joint function well. |
| KEY WORDS Joint instability Ankle joint Anterior talofibular ligament Calcaneofibular ligament |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘松波,李兴华,刘化文,王爱国.自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定[J].中国骨伤,2022,35(2):172~177 |
| 英文格式: | LIU Song-bo,LI Xing-hua,LIU Hua-wen,and WANG Ai-guo.Reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon in the treatment of chronic lateral ankle instability[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(2):172~177 |
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