自体与异体肌腱微创重建踝关节外侧韧带的临床对比研究  

Comparison of semitendinosns tendon autograft and tendon allograft for reconstruction of the ligaments of the lateralankle via minimally inwsive method

作　　者：胡牧[1] 徐向阳[1] 刘津浩[1] 朱渊[1] 王碧波[1] 郭常军[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,200025

出　　处：《中华骨科杂志》2014年第4期448-453,共6页Chinese Journal of Orthopaedics

摘　　要：目的比较应用自体半腱肌腱与同种异体肌腱微创移植重建踝关节外侧韧带的临床疗效。方法回顾性分析2006年9月至2011年6月采用微创手术治疗慢性踝关节外侧不稳患者资料。其中应用自体半腱肌腱重建踝关节外侧韧带（白体组）32例，男19例，女13例；年龄17-62岁，平均32．4岁。同期应用同种异体肌腱重建踝关节外侧韧带（异体组）36例，男22例，女14例；年龄15-67岁，平均34．2岁。两组患者均采用相同的手术方法重建距腓前韧带及跟腓韧带。结果自体组手术时间[（85．5±11．5）min]长于异体组[（58．1±10．2）mini，发热天数异体组[（5．5±1．5）d]长于自体组[（2．5±1．2）d]。自体组23例随访（33．5±6．7）个月，异体组26例随访（28．5±6．7）个月。美国足踝外科协会（AOFAs）踝与后足评分，自体组术前（62．3±8．2）分，术后（95．13±7．5）分；异体组术前（60．2±8．4）分，术后（94．8±5．5）分。5例患者（自体组3例、异体组2例）在不平地面行走时，踝关节有残余不稳定。自体组1例患者平整地面行走踝关节有残余不稳定。自体组无一例膝部肌腱供区功能障碍。术后AOFAS评分自体组16例为优，5例为良，2例为差；异体组17例为优，5例为良，4例为差。应力位X线片示自体组距骨倾斜角平均由14．0。减少到3．8。，异体组平均由13．0。减少到3．6。；距骨前移距离自体组平均由12-3mm减少到4．6mm，异体组平均由11．5mm减少到4．3mm。结论自体肌腱与同种异体肌腱移植重建踝关节外侧韧带的临床疗效无差异，但自体肌腱愈合时间较异体肌腱快，而异体肌腱具有损伤小，手术简便等优点。Objective To study on the different results of a minimally invasive method to reconstruct the ligaments of the lateral ankle using semitendinesns tendon autograft and tendon allograft. Methods Data of 68 patients with chronic ankle insta-bility who had undergone lateral ligament reconstruction from September 2006 to June 2011 were retrospectively analyzed. In the group of semitendinesus autagraft, there were 32 patients （ 19 males, 13 females） with an average age of 32.4 years old. Semitendi-nosus was harvested through 2 small knee incisions. While in the group of tendon allagraft, there were 36 patients （22 males, 14 females） with an average age of 34.2 years old. For the ankle reconstruction, 4 small incisions of 5 mm each were made at the me- dial and lateral side of the fibular tip, the talar neck, and the middle of the calcaneus. Anatomical reconstruction of the anterior talofibular ligament and ealeaneofibular ligament was then pedormed through these small incisions. AOFAS questionnaires were used to measure clinical outcomes, donor site morbidity and patients＂ satisfaction. Preoperative and postoperative stress tests were performod and radiographic parameters were measured. Results The average operation time of the autograft group 85.5 ± 11.5 rain was significantly longer than that in the allagraft group 58.1±10.2 min, but the fever days in the latter 5.5±1.5 d was signifi- cantly longer than in the former 2.5±1.2 d. In autograft group, 23 patients get followed up, and the mean period of follow-up was 33.5±6.7 months. The mean AOFAS score increased from 62.3±8.2 to 95.1±7.5. In allograft group, 26 patients got followed up, and the mean period of follow-up was 28.5＋6.7 months. The mean AOFAS score increased from 60.2±8.4 to 94.8±5.5. There were 5 patients （3 of autugraft group and 2 of allograft group） with residual instability on uneven ground. One case of the autologous group had instability in daily life. No patient presented weakness or disability in the donor site. The satisfac

关 键 词：踝关节 侧副韧带 移植 同种 

分 类 号：R687.2[医药卫生—骨科学]