腓骨肌腱沟后内侧加深法治疗慢性腓骨肌腱滑脱症  

Posteromedial peroneal tendon groove deepening treatment of the chronic subluxation of the peroneal tendons

作　　者：胡牧[1] 徐向阳[1] 郭常军[1] 李星辰[1] 朱尧卿[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院北院骨科,201801

出　　处：《中华骨科杂志》2016年第6期329-335,共7页Chinese Journal of Orthopaedics

基　　金：国家自然基金面上项目（81272051）

摘　　要：目的 探讨腓骨肌腱沟后内侧加深新方法治疗慢性腓骨肌腱滑脱症的临床疗效。方法 2006年3月至2012年10月21例腓骨肌腱慢性滑脱患者采用腓骨肌腱沟后内侧加深新方法联合腱鞘修补术进行治疗。男15例，女6例；年龄17~57岁，平均29.1岁；21例均为单侧损伤，其中左侧9例，右侧12例。首次滑脱原因：篮球运动损伤5例，足球运动损伤4例，羽毛球运动损伤4例，跳舞扭伤3例，普通行走扭伤3例，自行车运动损伤1例，乒乓球运动损伤1例；Ⅰ度滑脱5例，Ⅱ度滑脱9例，Ⅲ度滑脱5例，IV度滑脱2例；全部患者均有踝部扭伤史，但无踝部骨折史。21例患者均采用腓骨肌腱沟后内侧加深新方法联合腱鞘修补术手术治疗。术后采用视觉模拟疼痛评分（visual analogue scale，VAS）和美国足踝外科协会踝与后足评分标准（American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale，AOFAS-AH）对术前、术后足部功能进行评估。结果 21例患者均顺利完成手术，手术时间30~70 min，平均50 min；术中出血量为30~60 ml，平均为40 ml。16例获得随访，随访时间24~69个月，平均24.5个月。术后末次随访时AOFAS-AH评分为80~100分，其中15例患者为优，1例为良，优良率为100%（16/16）；AOFAS-AH评分从术前的平均（55.2±7.1）分提高到术后的平均（93.6±5.6）分；VAS评分由术前（5.3±2.1）分降至术后（1.2±1.1）分。所有患者术后对穿鞋，地面是否平整均无特殊要求，步态均正常。所有患者手术切口均I期愈合，无一例发生切口感染、皮肤坏死及腓肠神经、血管损伤等并发症。5例患者后足（尤其是距下关节）内、外翻受限，经康复训练后改善。结论 腓骨肌腱沟后内侧加深法手术方法简单、创伤小、符合生物力学原理，其联合腱鞘修补术治疗慢性腓骨肌腱滑脱疗效满意，治疗时应根据患者损伤机制及个体状况选用最�Objective To investigate the clinical curative result of the new method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation. Methods From March 2006 to October 2012, 21 patients （15 male, 6 female） with chronic peroneal tendon subluxation via a novel method of postermedial deepen of the fibular groove. In this group：I grade 5 cases; II grade 9 cases; III grade 5 cases; IV grade 2 cases. All patients were followed up for at least 24 months. The American Orthopaedic Foot and Ankle Society （AOFAS） Ankle-Hindfoot scale score and visual analogue score （VAS） were used to evaluate the clinical outcomes. Operation time, time to heal and complications were also recorded. Results The average operation time was 50 minutes （30-70 minutes）. The blood loss was 30-60 ml, average 40 ml. All incisions healed after operation, no case of incision infection, skin necrosis and sural nerve,vascular injuryed. Mean AOFAS score was significantly increased from （55.2±7.1） preoperative to （93.6±5.6） postoperative. 15 patients with excellent, good for 1 cases. The excellent and good rate was 100% （16/16）. VAS score by an average of （5.3±2.1） points down to （1.2±1.1） points postperative. All the patients can wear normal shoes postoperative, waking with normal gait. No patients had peroneal tendon tenosynovitis, tendon adhesion, fracture of lateral malleolus and other serious complications, no dislocation recurrent, strength of the peroneal muscle returns to normal. Conclusion The novel method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation was safe and effective for ankle instability with a relatively short time.

关 键 词：肌腱病 临床方案 疗效比较研究 

分 类 号：R687[医药卫生—骨科学]