同种异体肌腱解剖重建修复慢性踝关节不稳  

Anatomical reconstruction with allogeneic tendon graft for chronic ankle instability

作　　者：沙勇[1] 唐辉[1] 丁晶[1] 徐永清[1] 李福兵[1] 阮默[1] 李春晓[1] 

机构地区：[1]解放军成都军区昆明总医院骨科中心,云南省昆明市650032

出　　处：《中国组织工程研究》2014年第27期4401-4405,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:同种异体肌腱解剖重建应用于踝关节修复重建的报道目前较少。目的:分析运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳的临床疗效。方法:运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳26例,其中跟腓韧带和距腓前韧带同时损伤或松弛18例,距腓前韧带单独损伤或松弛8例。采用美国足踝外科协定(AOFAS)评分及Good评级评估踝关节功能,并进行患侧与健侧踝关节背伸、跖屈活动度、后足活动度比较。结果与结论:所有患者治疗后均获得随访,随访时间9-24个月,平均15个月。所有患者均未出现复发性踝关节外侧不稳,美国足踝外科协定(AOFAS)评分:同时修复跟腓韧带和距腓前韧带组,治疗前(48.4±3.7)分,治疗后(88.2±3.8)分,治疗后较治疗前平均提高39.8分;单独修复距腓前韧带组治疗前(50.0±6.4)分,治疗后(89.5±3.4)分,治疗后较治疗前平均提高39.5分。Good评级优19例,良6例,可1例,优良率96%。患者均无严重并发症。结果提示应用深低温冷冻保存同种异体肌腱解剖重建踝关节外侧韧带治疗踝关节慢性外侧不稳,增大了腱骨接触面积,增加了骨腱愈合的概率,增强了踝关节的稳定性,其远期疗效仍待进一步评估。BACKGROUND：There is little evidence on the use of al ogeneic tendon graft in the reconstruction of ankle joint. OBJECTIVE：To explore the clinical outcome of anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft in patients with chronic ankle instability. METHODS：Twenty-six patients with chronic lateral instability underwent anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon. There were 18 cases of simultaneous injury or chalasia in calcaneofibular ligament and anterior talofibular ligament, and 8 cases of anterior talofibular ligament injury or chalasia. The ankle joint function was evaluated according to AOFAS scale and Good classification. The affect ankle and healthy ankle were compared in the extension, plantar flexion activity, and metaleg activity. RESULTS AND CONCLUSION：Al the 26 patients were fol owed up for 9-24 months with a mean of 15 months. No cases appeared recurrent ankle lateral instability. The mean AOFAS score in the group of calcaneofibular ligament and anterior talofibular ligament was improved from （48.4±3.7） points preoperatively to （88.2±3.8） postoperatively, while that in the group of anterior talofibular ligament was improved from （50.0±6.4） points preoperatively to （89.5±3.4） points postoperatively. According to Good score, there were excellent in 19 feet, good in 6 feet, fair in 1 foot, with an excellent and good rate up to 96%. No serious complication was occurred in this group. Anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft can increase the tendon-bone contact area, improve the rate of tendon healing, and enhance the stability of ankle joint in patients with chronic ankle instability. Further studies are needed to verify its long-term efficacy.

关 键 词：组织构建 同种异体肌腱 移植 解剖重建 慢性踝关节不稳 深低温冷冻保存 跟腓韧带 距腓前韧带 

分 类 号：R318[医药卫生—生物医学工程]