腓骨侧单隧道解剖重建与改良Brostrom法缝合修复治疗慢性踝关节外侧不稳定的对比研究  

EFFECTIVENESS COMPARISON BETWEEN MODIFIED Brostrom METHOD REPAIR AND ANATOMICAL RECONSTRUCTION WITH SINGLE FIBULAR TUNNEL IN TREATMENT OF CHRONIC LATERAL ANKLE INSTABILITY

作　　者：刘建永[1] 

机构地区：[1]潍坊市人民医院骨关节外科,山东潍坊261041

出　　处：《中国修复重建外科杂志》2015年第10期1214-1220,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：潍坊市科技局项目(201104103)~~

摘　　要：目的比较距腓前韧带（anterior talofibular ligament，ATFL）及跟腓韧带（calcaneofibular ligament，CFL）腓骨侧单隧道解剖重建与改良Brostrom法缝合修复治疗慢性踝关节外侧不稳定的疗效。方法对20具冰冻新鲜成年尸体踝关节标本解剖，观测ATFL、CFL韧带形态及血管神经分布。2008年1月－2011年12月，对48例慢性踝关节外侧不稳定患者，通过前瞻性随机分为两组（n=24），分别行韧带改良Brostrom法紧缩缝合修复（A组）或基于尸体解剖研究数据的腓骨侧单隧道解剖重建（B组）。两组患者性别、年龄、身体质量指数、侧别、致伤原因、初次受伤至手术时间及术前距骨倾斜角、距骨前移以及踝关节跖屈、背伸、外翻、内翻活动度、美国矫形足踝协会（AOFAS）评分及疼痛视觉模拟评分（VAS）比较，差异均无统计学意义（P〉0.05），具有可比性。术后比较两组患者影像学指标及踝关节活动度，采用AOFAS评分、VAS评分评定疗效。结果术后两组患者切口均Ⅰ期愈合，无神经损伤、感染、皮缘坏死等并发症发生。两组均获随访，随访时间2-5年，平均3.4年。随访期间无不稳定复发。术后2年两组患者距骨倾斜角、距骨前移、AOFAS评分及VAS评分均较术前显著改善（P〈0.05）。术后2年两组间踝关节跖屈、背伸、外翻活动度及VAS评分比较差异无统计学意义（P〉0.05），踝关节内翻活动度、距骨倾斜角、距骨前移、AOFAS评分B组优于A组（P〈0.05）。AOFAS评分各项目中，两组疼痛、异常步态、支撑与自主功能、踝关节屈伸、后足活动及对线评分比较，差异无统计学意义（P〉0.05）；地面步行、最大步行距离、踝关节稳定性B组优于A组（P〈0.05）。结论 与改良Brostrom法缝合修复相比，通过腓骨侧单隧道重建ATFL、CFL在避免后足僵硬同时可有效恢复踝关节外侧稳定性，适用于青壮年及翻修手�Objective To compare the effectiveness between modified Brostrom method repair and anatomical reconstruction anterior talofibular ligament （ATFL） and calcaneofibular ligament （CFL） with single fibular tunnel for chronic lateral ankle instability. Methods Twenty ankle specimens of fresh cadaver were dissected to provide the anatomic data of ATFL and CFL and to observe the neurovascular distribution. Between January 2008 and December 2011, 48 patients （48 ankles） with chronic lateral ankle instability were randomly divided to groups A and B （n=24）. The direct repair of ATFL and CFL by modified Brostrom method was performed in group A, and anatomic double-bundle reconstruction of ATFL and CFL with free semitendinosus tendon autograft in group B. There was no significant difference in sex, age, body mass index, injury side, the causes of injury, interval of injury and operation, talar tilt angle, talus forward shift, ankle plantar flexion, dorsiflexion, valgus, varus, American Orthopaedic Foot and Ankle Society （AOFAS） score, and visual analogue score （VAS） between 2 groups （P〉0.05）. The image parameters and range of motion were compared between 2 groups after operation; AOFAS and VAS scores were used to evaluate the effectiveness. Results All the incisions healed by first intention in 2 groups; no complication of nerve injury, infection, or skin necrosis was observed. All the patients were followed up 2-5 years （mean, 3.4 years）; no subtalar stiffness or recurrent instability occurred during follow-up. The talar tilt angle, talus forward shift, AOFAS score, and VAS score were significantly improved at 2 years after operation when compared with preoperative ones in 2 groups （P〈0.05）. There was no significant difference in range of motion of ankle plantar flexion, dorsiflexion, and ankle valgus, and VAS score between 2 groups （P〉0.05）, but group B was significantly better than group A in the range of motion of ankle varus, talar tilt angle, talus forward shift, and AOFAS s

关 键 词：踝关节外侧不稳定 距腓前韧带 跟腓韧带 解剖重建 半腱肌腱 

分 类 号：R687.3[医药卫生—骨科学]