慢性踝关节外侧不稳定距腓前韧带和跟腓韧带解剖重建  

Double-bundle Arthroscopic Reconstruction of ATFL and CFL for 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：《中国运动医学杂志》2016年第2期126-131,共6页Chinese Journal of Sports Medicine

基　　金：山东省潍坊市科技局立项课题(编号201104103)

摘　　要：目的：探讨踝关节镜微创技术结合解剖重建距腓前韧带/跟腓韧带（ATFL/CFL）治疗慢性踝关节外侧不稳定的疗效。方法：自2010年1月至2013年12月共计52例（52踝）保守治疗无效的慢性踝关节外侧不稳定（ATFL/CFL损伤）患者纳入研究,随机分为A、B两组,A组采用改良brostrom法（锚钉-韧带-骨膜双重锚定法）缝合修复,B组取自体半腱肌腱行ATFL/CFL双束解剖重建。对术前、术后2年AOFAS足踝评分、患者主观感觉、VAS疼痛评分、距骨前移及倾斜、踝关节活动度进行评估,对比两组的疗效差异。结果：平均随访34.7月（2~5年）,两组患者均无感染、神经损伤、皮缘坏死、后足僵硬等并发症,半腱肌腱供区无不适,末次随访无不稳定复发。术后2年A、B两组在踝关节跖屈、背伸、外翻活动度上无差异,在踝关节内翻（P=0.025）、距骨倾斜（P=0.025）与前移（P=0.020）改善方面B组优于A组,重建相较于修复显示出更佳的稳定性。AOFAS评分A组由术前46.90±9.10改善至术后2年87.15±4.22（P=0.000）,B组由术前46.50±9.95改善至术后2年93.70±5.00（P=0.000）,术后2年组间比较存在差异（P=0.035）。两组在疼痛、异常步态、自主活动及功能、前后屈伸活动、后足活动及对线评分项目上无明显差异;在地面步行（P=0.045）、最大步行距离（P=0.042）、稳定性评分（P=0.045）上组间有差异。VAS视觉疼痛评分A组由术前7.10±5.30改善至术后2年2.05±1.95（P=0.000）,B组由术前6.95±4.40改善至术后2年2.12±1.88（P=0.000）,术后2年组间比较无差异（P=0.450）。主观评级术后2年A组优良率87.5%,B组95.83%（P=0.001）;两组内AOFAS客观评分与主观评级相当,主客观评价统一度较好。结论：依托关节镜技术,借鉴尸体解剖数据,半腱肌腱双束解剖重建ATFL/CFL在有效恢复踝关节外侧稳定性的同时避免了后足僵硬等常见并发症,尤其适用于功能期望值�Purpose The purpose of this study was to evaluate the functional outcome of arthroscopic double-bundle reconstruction of anterior talofibular ligament（ATFL）and calcaneofibular ligament（CFL）in treating chronic lateral ankle instability. Methods 52 patients with chronic lateral ankle instability treated in our hospital from 2010 to 2013 were divided into group A and group B. Patients in group A directly underwent reparation of ATFL and CFL,and in group B underwent arthroscopic double-bundle reconstructions of ATFL and CFL with autos semitendinosus tendon. Their average age at surgery was 39.10 ±10.55 years. Their range of motion,AOFAS scores,VAS pain scores,subjective satisfaction,alar tilt angles,and anterior talar translation were evaluated. Results The patients were averagely followed up for 34.7 months（2-5 years）. No complications such as subtalar stiffness,infection and recurrent instability were found at the follow-up. Though there was no significant difference in plantar flexion,dorsal expansion,and valgus between the two groups 2 years after the surgery,however the talar tilt angles,ankle varus,anterior talar translation,and joint stability were obviously improved in group B as compared with the group A（P0.05）. The AOFAS score in group A improved from 46.90 ± 9.10 preoperatively to 87.15 ± 4.22 postoperatively（P=0.000）and in group B from 46.50 ± 9.95 preoperatively to 93.70 ± 5.00 postoperatively（P =0.000）,and the difference in improvement of AOFAS score between the two groups still existed（P =0.035）. There were no differences in pain,gait,autonomic activity,hindfoot extension and flexion,and alignment between the two groups,however there were differences in walking ability（P=0.045）,walking distance（P=0.042）,and joint stability（P=0.045）between the two groups after the surgery. The VAS pain score in group A decreased from 7.10 ± 5.30 preoperatively to 2.05 ± 1.95 postoperatively（P=0.000）,and in group B from 6.95 ± 4.40 preoperatively to 2.12 ± 1.88 postope

关 键 词：踝关节不稳定 距腓前韧带 跟腓韧带 解剖重建 修复 关节镜 

分 类 号：R687.3[医药卫生—骨科学]